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Cao C, Chen Y, Li J, Xu Q, Liu X, Zhao R, Jiang Q, Zhou Q. Short-term reproductive outcomes analysis and prediction of the modified uterine stent treatment for mild to moderate intrauterine adhesions: experience at a single institution. BMC Womens Health 2024; 24:252. [PMID: 38654192 PMCID: PMC11036709 DOI: 10.1186/s12905-024-03098-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND To evaluate the efficacy of modified uterine stent in the treatment of mild-to-moderate intrauterine adhesions and explore the relative indicators affecting prognosis prediction. METHODS A total of 115 patients with mild-to-moderate intrauterine adhesions received a modified uterine stent placement after hysteroscopy adhesiolysis. The second-look hysteroscopy operated after 3 months surgery, and the third-look hysteroscopy operated after 6 months surgery if necessary. The stent was removed when the cavity shape was repaired, then the reproductive outcomes were followed up one year. RESULTS Menstrual blood volume, endometrial thickness and volume had increased significantly after 3 months surgery. The rates of cavity repaired were 86.96% (100/115) after 3 months surgery and 100% (115/115) after 6 months surgery cumulatively. Endometrial thickness after 3-months surgery was positively associated with uterine cavity shape repaired (P<0.01). The receive operating characteristic (ROC) curve showed the rate of uterine cavity shape repaired predicted by the model was 0.92, based on the endometrial thickness after 3-months surgery. The rate of pregnancy was 86.09% (99/115) in one year, while the rate of miscarriage accounted for 26.26% (26/99). The median time interval between stent removal and subsequent conception was 3 months. It showed adhesion recurrence was the risk factor for subsequent pregnancy (P<0.01). CONCLUSIONS A modified uterine stent placement under hysteroscopy was an effective approach for mild-to-moderate intrauterine adhesions, which is easy to operate and worthy for clinical promotion. Endometrial thickness measured by ultrasonography probably has predictive value in adhesion recurrence and subsequent pregnancy. TRIAL REGISTRATION ChiCTR2100051524. Date of registration (retrospectively registered): 26/09/2021.
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Affiliation(s)
- Chaoxia Cao
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, 401147, Yubei District, Chongqing, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, 401147, Yubei District, Chongqing, China
- Chongqing Research Center for Prevention and Control of Maternal and Child Diseases and Public Health, 401147, Yubei District, Chongqing, China
| | - Yinan Chen
- Department of Mathematics, School of Mathematics and Physics, University College London, Gower St, London, WC1E 6AE, UK
| | - Jinjin Li
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Qianjie Xu
- Department of Health Statistics, School of Public Health, Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Xiaoli Liu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, 401147, Yubei District, Chongqing, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, 401147, Yubei District, Chongqing, China
- Chongqing Research Center for Prevention and Control of Maternal and Child Diseases and Public Health, 401147, Yubei District, Chongqing, China
| | - Ruikun Zhao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Quanjia Jiang
- Department of Obstetrics and Gynecology, Chongqing Shapingba Maternity and Child Healthcare Hospital, Shapingba District, Chongqing, 401331, China
| | - Qin Zhou
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China.
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Xu P, Xu H, Lu Q, Ling S, Hu E, Song Y, Liu J, Yi B. Reproductive outcomes following copper‑containing intrauterine device after hysteroscopic lysis for intrauterine adhesions. Exp Ther Med 2024; 27:175. [PMID: 38476904 PMCID: PMC10928823 DOI: 10.3892/etm.2024.12463] [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: 04/07/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
The present study aimed to investigate the reproductive outcomes of copper-containing intrauterine devices (IUDs) after hysteroscopic lysis in patients with mild to severe intrauterine adhesions (IUAs), according to the American Fertility Society (AFS) classification. Therefore, a prospective randomized controlled study was conducted at the Affiliated Jinhua Hospital of Wenzhou Medical University (Jinhua, China). A total of 173 women with IUAs were initially recruited between January 2020 and June 2021 and were then randomized to the copper-containing IUD group or the no barrier device group. Following hysteroscopic procedure, the fertility and obstetric outcomes were analyzed. Among the 173 patients enrolled, a total of 109 participants completed the study protocol. The results showed that AFS scores were not significantly different between the two groups prior to hysteroscopy. In addition, no statistically significant differences were recorded in pregnancy and live birth rates between the copper-containing IUD and no barrier device groups. Overall, the results of the current study indicated that the copper-containing IUDs had no positive effect on pregnancy and live birth rates in patients with mild to severe IUAs after hysteroscopic adhesiolysis. The present trial was retrospectively registered in the Chinese Clinical Trial Registry on 28th December 2023 (registration no. ChiCTR2300079233).
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Affiliation(s)
- Pan Xu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Heng Xu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Qiaoqiao Lu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Shanshan Ling
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - E Hu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Ying Song
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Jie Liu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Bixia Yi
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
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Zhou C, Li X, Mo Y, Wei F. The value of ultrasound parameters in predicting the efficacy of transabdominal ultrasound-guided suction curettage alone in the treatment of cesarean scar pregnancy. J Obstet Gynaecol Res 2024. [PMID: 38520306 DOI: 10.1111/jog.15927] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To investigate the value of ultrasound parameters in assessing the efficacy of transabdominal ultrasound (TAUS)-guided suction curettage alone for cesarean scar pregnancy (CSP). METHODS Secondary retrospective analysis of a prospective study consisted of 137 women diagnosed with CSP who were performed TAUS-guided suction curettage alone for the first time at Maternity and Child Health Care of Guangxi Zhuang Autonomous Region in China. Prior to surgery, an ultrasound examination was conducted. Based on the need for secondary intervention, the patients were categorized into failure group and success group, and the predictive factors for failure of TAUS-guided suction curettage alone were analyzed. RESULTS Multivariate logistic regression showed that maximum diameter of the gestational sac>29 mm (odds ratio [OR] = 4.043, 95% CI: 1.100-14.862), residual myometrium thickness ≤1.8 mm (OR = 3.719, 95% CI: 1.148-12.048) and chorionic villi thickness at the scar >4.7 mm (OR = 15.327, 95% CI: 4.617-50.881) were independent predictors of failure in TAUS-guided suction curettage alone for CSP. Furthermore, the logistic regression model that was jointly constructed by these three predictors demonstrated an area under the curve, sensitivity, specificity, and Youden index of 0.913, 0.912, 0.864, and 0.776, respectively. CONCLUSION The maximum diameter of the gestational sac, residual myometrium thickness, and chorionic villi thickness at the scar has certain predictive efficacy of TAUS-guided suction curettage alone for CSP. Nevertheless, it is more valuable to apply the model of this study, composed of the three ultrasound parameters, for this prediction purpose.
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Affiliation(s)
- Chunqiao Zhou
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xinyan Li
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yu'ning Mo
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fangtao Wei
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
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Gilyadova AV, Ishchenko AA, Samoilova SV, Shiryaev AA, Novruzaliyeva MF, Efendiev KT, Alekseeva PM, Loschenov VB, Reshetov IV. Comparative study of treatment efficacy in severe intraepithelial squamous cell lesions and preinvasive cervical cancer by conization and chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy. Photodiagnosis Photodyn Ther 2024:104060. [PMID: 38521149 DOI: 10.1016/j.pdpdt.2024.104060] [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: 11/20/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Cervical cancer (CC) occupies a leading position in incidence among young women of reproductive age. In this connection, it is urgent to search for the most effective approaches to the diagnosis and treatment of this pathology. The purpose of the study was to evaluate the effectiveness of the PDT method using Cе6 with the control of the photobleaching using video and spectral fluorescence diagnostic methods, to develop the method of fluorescence-assisted systemic photodynamic therapy mediated with chlorin e6 for treatment CIN 3 and CIS. MATERIALS AND METHODS A randomized comparative clinical study was conducted involving 94 women aged 18 to 49 years with histologically verified severe intraepithelial squamous cell lesions of the cervix or preinvasive cervical cancer. The patients were included in 2 groups: in the first group conization of the cervix was performed with curettage of the remaining part of the cervical canal; patients in the second group underwent the chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy. RESULTS The absolute majority of patients in the main group after the first course of chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy showed normalization of cytological parameters and colposcopic picture, while women from the comparison group showed signs of cervical lesions statistically significantly more often. These changes corresponded to the dynamics of the proliferation markers expression in the cells of intraepithelial squamous cell lesions. Also, patients of the second group who were planning a pregnancy had better reproductive outcomes after treatment compared to those of the first group. CONCLUSION In general, higher clinical efficacy and safety of the use of the chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy in the treatment of intraepithelial squamous cell lesions and preinvasive cervical cancer have been established compared to the use of standard treatment methods.
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Affiliation(s)
- A V Gilyadova
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;; National Medical Research Center Treatment and Rehabilitation Center, Ministry of Health of the Russian Federation, Ivankovskoe highway 3, Moscow, 125367 Russia.
| | - A A Ishchenko
- National Medical Research Center Treatment and Rehabilitation Center, Ministry of Health of the Russian Federation, Ivankovskoe highway 3, Moscow, 125367 Russia.
| | - S V Samoilova
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - A A Shiryaev
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - M F Novruzaliyeva
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - K T Efendiev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - P M Alekseeva
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - V B Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - I V Reshetov
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
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Yao Y, Liu W, Zhang X, Su N, Huang L, Nong Y, Xiao X, Liu F. Normal weight obesity is associated with lower AFC and adverse IVF outcomes. Front Endocrinol (Lausanne) 2024; 15:1332995. [PMID: 38455649 PMCID: PMC10917978 DOI: 10.3389/fendo.2024.1332995] [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] [Received: 11/04/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024] Open
Abstract
Background Body weight could be classified into underweight, normal weight and overweight according to percentage of body fat (%BF), and normal weight obesity (NWO) is defined as a normal BMI but a high %BF. While the impact of NWO in women fecundity remain unknow. Therefore, this study aimed to investigate the associations between %BF and reproductive outcomes among in vitro fertilization (IVF) women with normal BMI. Methods A total of 469 women were included in this study and were classified into low %BF, normal %BF and high %BF according to previous study. Multivariate generalized regression models were employed to evaluate the associations of %BF with ovarian reserve parameters, IVF outcomes and early pregnancy outcomes. We further run sensitivity analyses by restricted the analysis to young women and those only with tubal factor, respectively. Results About 32.2% of normal BMI women were misclassified according %BF, with 16.4% of them were low %BF and 15.8% were high %BF. The high %BF group had significantly lower antral follicle count (AFC) than normal %BF groups, and the AFC showed a tendency of decrease as %BF increased. In sensitivity analysis in young women, high %BF group also had significantly lower number of good-quality embryos when compared to normal %BF groups. The results expanded to all IVF outcomes when analysis restricted to tubal factor women. Conclusion In summary, misclassifications of body weight status based on BMI are common according to %BF, and NWO is associated with adverse reproductive outcomes.
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Affiliation(s)
- Yangcheng Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Wenjuan Liu
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiqian Zhang
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Nianjun Su
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Li Huang
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yingqi Nong
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaomin Xiao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Fenghua Liu
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
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Yan N, Song J, Jie H, Lee P, Liu S, Yuan Y. Serum uric acid did not affect embryonic and pregnancy outcomes in women without PCOS during IVF procedures. Front Endocrinol (Lausanne) 2024; 15:1310122. [PMID: 38444583 PMCID: PMC10912854 DOI: 10.3389/fendo.2024.1310122] [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] [Received: 10/09/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
Objectives Serum uric acid (UA) levels are associated with many systemic diseases. A previous study confirmed the association between high serum uric acid levels and poor prognosis of in vitro fertilization (IVF) treatment in polycystic ovary syndrome (PCOS) patients. This study aimed to explore the correlation between serum uric acid levels and reproductive outcomes in patients without PCOS. Methods A retrospective study that included 1057 patients who underwent pre-implantation genetic testing for monogenic disorders (PGT-M) treatment from January 2013 to December 2020 was conducted. The study population was further divided into 3 groups according to serum UA levels: the ≤250 μmol/L group, the 251-360 μmol/L group, and the >360 μmol/L group. The controlled ovarian hyperstimulation (COH) treatment outcomes, embryonic treatment outcomes and pregnancy outcomes of the first frozen embryo transfer (FET) cycle were compared among groups. Multivariable linear regression and binary regression were applied to detect the association between IVF outcomes and serum uric acid levels. Results The number of retrieved oocytes, fertilization rate, viable embryo rate, blastocyst formation rate and euploid rate were not associated with serum uric acid levels. The mature oocyte rate was negatively correlated with serum uric acid levels. The pregnancy outcomes of the first FET cycle were also not associated with serum uric acid levels. After adjustment for BMI, the perinatal outcomes were not associated with serum uric acid levels. Conclusion IVF treatment outcomes were not associated with serum uric acid levels in patients without PCOS.
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Affiliation(s)
- Niwei Yan
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
- Department of Surgery, Li Ka-shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Junli Song
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Huiying Jie
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Pingyin Lee
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Simin Liu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Yuan Yuan
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
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Mei Y, Lin Y, Chen Y, Zheng J, Ke X, Liang X, Wang F. Preimplantation genetic testing for aneuploidy optimizes reproductive outcomes in recurrent reproductive failure: a systematic review. Front Med (Lausanne) 2024; 11:1233962. [PMID: 38384413 PMCID: PMC10879326 DOI: 10.3389/fmed.2024.1233962] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Recurrent reproductive failure (RRF) is a common pregnancy complication, imposing great physical, emotional and financial burden for the suffered couples. The leading cause of RRF is believed to be aneuploid embryo, which could be solved by preimplantation genetic testing for aneuploidy (PGT-A) in theory. With molecular genetic development, PGT-A based on comprehensive chromosomal screening (CCS) procedures and blastocyst biopsy is widely applied in clinical practice. However, its effects in RRF were not defined yet. Methods A systematic bibliographical search was conducted without temporal limits up to June, 2023. Studies about the effects of PGT-A based on CCS procedures and blastocyst biopsy in RRF were included. Results Twenty studies about the effects of PGT-A based on CCS procedures and blastocyst biopsy in RRF were included. It revealed that PGT-A could optimise the reproductive outcomes of RRF sufferers, especially in those with advanced age. However, in patients with multiple occurrences of pregnancy losses, the benefits of PGT-A were limited. Discussion More randomized controlled trials with large sample size are required to evaluate the benefits of PGT-A in RRF sufferers and identify which population would benefit the most.
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Affiliation(s)
| | | | | | | | | | | | - Fang Wang
- Department of Reproduction and Infertility, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Guo QC, Yao W, Liu C, Deng TR, Li J, Liao HM, Tian WQ, Wang Y, Du YY, Li YF. Associations of personal care products use with reproductive outcomes of IVF/ICSI treatment. Front Endocrinol (Lausanne) 2024; 14:1320893. [PMID: 38327901 PMCID: PMC10847553 DOI: 10.3389/fendo.2023.1320893] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction Personal care products (PCPs) contain a number of endocrine-disrupting chemicals (EDCs) that could potentially affect the reproductive function in women of childbearing age. However, studies focused on the effects of PCPs use on reproductive outcomes are very limited. The current study aimed to explore the relationships between PCPs use patterns and reproductive outcomes in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Methods A total of 1500 women from the Tongji Reproductive and Environmental (TREE) study between December 2018 and January 2020 were included in this study. Participants provided characteristics of PCPs use within the previous three months. Retrieved oocyte number, mature oocyte number, two distinct pronuclei (2PN) zygote number, fertilization rate, cleavage rate, blastocyst formation rate, implantation, clinical pregnancy, miscarriage, and live birth were followed up as reproductive endpoints. Generalized linear regression model was utilized to assess the associations between various categories of PCPs use and reproductive endpoints of IVF/ICSI. Results After adjusting for relevant covariates, women who used skin care products ≥14 times per week had a reduction of 22.4% in the maturation rate (95% CI: -39.2%, -1.6%) compared to participants who did not use skin care products. After transferring fresh embryos, women who used cosmetics 1-2 times per week (adjusted OR = 2.2, 95% CI: 1.0, 4.8) or 3-7 times per week (adjusted OR = 2.5, 95% CI: 1.2, 5.2) had a higher possibility of miscarriage than those who did not use cosmetics. There was negative association between the use of gel or soap and the cleavage rate among women aged < 30 years old (P for interaction = 0.01). Among women with BMI ≥ 24 kg/m2, the use of gel or soap was negatively associated with the blastocyst formation rate (P for interaction = 0.04), while cosmetics use was negatively associated with the maturation rate (P for interaction = 0.001). Conclusion Our findings suggest that the use of PCPs in women of reproductive age have a potential adverse impact on IVF/ICSI outcomes, particularly skin care and cosmetic products.
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Affiliation(s)
- Qing-Chun Guo
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen Yao
- Department of Reproductive Medicine, General Hospital of Central Theater Command, Wuhan, Hubei, China
| | - Chong Liu
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao-Ran Deng
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Juan Li
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hong-Mei Liao
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen-Qu Tian
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Wang
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yao-Yao Du
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu-Feng Li
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Xia Z, Zhou R, Li Y, Meng L, Huang M, Tan J, Qiao F, Zhu H, Hu P, Zhu Q, Xu Z, Wang Y. Reproductive outcomes in couples with sporadic miscarriage after embryonic chromosomal microarray analysis. Ann Med 2023; 55:837-848. [PMID: 36869707 PMCID: PMC9987763 DOI: 10.1080/07853890.2023.2183986] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES Chromosomal microarray analysis (CMA) has been widely applied to genetic diagnosis in miscarriages in clinical practice. However, the prognostic value of CMA testing of products of conception (POCs) after the first clinical miscarriage remains unknown. The aim of this study was to evaluate the reproductive outcomes after embryonic genetic testing by CMA in SM couples. METHODS In this retrospective study, a total of 1142 SM couples referred for embryonic genetic testing by CMA, and 1022 couples were successfully followed up after CMA. RESULTS Among 1130 cases without significant maternal cell contamination, pathogenic chromosomal abnormalities were detected in 680 cases (60.2%). The subsequent live birth rate did not differ significantly between couples with chromosomally abnormal and normal miscarriage (88.6% vs. 91.1%, p = .240), as well as the cumulative live birth rate (94.5% vs. 96.7%, p = .131). Couples with partial aneuploid miscarriage had a higher likelihood of spontaneous abortion both in the subsequent pregnancy (19.0% vs. 6.5%, p = .037) and cumulative pregnancies (19.0% vs. 6.8%, p = .044) when compared with couples with chromosomally normal miscarriage. CONCLUSIONS SM couples with chromosomally abnormal miscarriage manifested with a similar reproductive prognosis to couples with chromosomally normal miscarriage. Key messagesCMA testing of POCs could provide an accurate genetic diagnosis for couples with SM.The live birth rate of couples with partial aneuploid miscarriage was as high as couples with chromosomally normal miscarriage, despite a higher risk of adverse pregnancy event.Among couples with the most common single aneuploid miscarriage, the cumulative live birth rates of couples with trisomy 16, sex chromosomal abnormalities and trisomy 22 were 94.1%, 95.8% and 84.0%, respectively.
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Affiliation(s)
- Zhengyi Xia
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Ran Zhou
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Yiming Li
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Lulu Meng
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Mingtao Huang
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Jianxin Tan
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Fengchang Qiao
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Hui Zhu
- Department of Premarital Care, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Ping Hu
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Qiaoying Zhu
- Department of Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Zhengfeng Xu
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Yan Wang
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
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Vissers J, Hehenkamp WJK, Brölmann HAM, Lambalk CB, Huirne JAF. Reproductive outcomes after laparoscopic resection of symptomatic niches in uterine cesarean scars: Long-term follow-up on the prospective LAPNICHE study. Acta Obstet Gynecol Scand 2023; 102:1643-1652. [PMID: 37700545 PMCID: PMC10619609 DOI: 10.1111/aogs.14647] [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: 10/27/2022] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION After incomplete healing of the uterine cesarean section scar, a niche can be observed; 24% of the women develop large niches with a residual myometrial thickness <3 mm. In these cases a laparoscopic resection is possible. The effect of this new treatment on fertility outcome is not known yet. This paper describes reproductive outcomes 2 years after a laparoscopic niche resection and compares women with or without secondary infertility at baseline. MATERIAL AND METHODS A prospective cohort study was performed, with consecutive inclusion of women between 2011 and 2019. Women with a niche in the uterine cesarean scar, with a residual myometrial thickness of <3 mm and with a desire to become pregnant, were scheduled to undergo a laparoscopic niche resection because of one or more of the following problems (1) postmenstrual spotting; (2) midcycle intrauterine fluid accumulation diagnosed during the fertility workup or (3) difficulties with a previous embryo transfer and preferring a surgical therapy. The study is registered in the ISRCTN register (ref. no. ISRCTN02271575) on April 23, 2013. RESULTS There were 133 (62%) women included with a desire to become pregnant, 88 with secondary infertility. In all, 83 had an ongoing pregnancy at the 2-year follow-up. The ongoing pregnancy rate in patients with previous fertility problems was 60.2% compared with 66.7% in patients without infertility (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.32-1.7). The OR for live births was 0.57 (95% CI 0.02-1.2). Overall, 8.3% of the pregnancies resulted in miscarriages by the 2-year follow-up. CONCLUSIONS The reproductive outcomes in women with and without previous fertility problems undergoing resection of a large niche are very promising and quite comparable in both groups. These results suggest, but do not prove, a beneficial effect of this therapy for these indications. The results support the design of future randomized controlled trials to evaluate the effect of niche resection vs expectant management to assess its additional value in women with or without fertility problems who desire pregnancy.
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Affiliation(s)
- Jolijn Vissers
- Department of Gynecology and Obstetrics, Research Institute “Reproduction and Development”Amsterdam UMC, Location VUmc, Amsterdam UMC‐Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Wouter J. K. Hehenkamp
- Department of Gynecology and Obstetrics, Research Institute “Reproduction and Development”Amsterdam UMC, Location VUmc, Amsterdam UMC‐Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Hans A. M. Brölmann
- Department of Gynecology and Obstetrics, Research Institute “Reproduction and Development”Amsterdam UMC, Location VUmc, Amsterdam UMC‐Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Cornelis B. Lambalk
- Department of Gynecology and Obstetrics, Research Institute “Reproduction and Development”Amsterdam UMC, Location VUmc, Amsterdam UMC‐Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Judith A. F. Huirne
- Department of Gynecology and Obstetrics, Research Institute “Reproduction and Development”Amsterdam UMC, Location VUmc, Amsterdam UMC‐Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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11
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Qiu J, Du T, Guo H, Mol BW, Lin J, Zhao D, Wang Y, Kuang Y, Li W. Does Day 3 embryo status matter to reproductive outcomes of single blastocyst transfer cycles? A cohort study. BJOG 2023; 130:1669-1676. [PMID: 37308804 DOI: 10.1111/1471-0528.17559] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate whether Day 3 (D3) embryo status matter to reproductive outcomes of blastocyst transfer cycles. DESIGN Retrospective cohort study. SETTING Assisted Reproduction Department of Shanghai Ninth People's Hospital, Shanghai, China. POPULATION A total of 6906 vitrified-thawed single blastocyst transfer cycles in 6502 women were included. METHODS Generalised estimated equation regression models were used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the associations between embryo status and pregnancy outcomes. MAIN OUTCOME MEASURES Biochemical pregnancy, miscarriage, live birth. RESULTS High-quality blastocysts derived from poor-grade D3 embryos had comparable pregnancy outcomes to those derived from high-grade D3 embryos (40.0% versus 43.2%, aOR 1.00, 95% CI 0.85-1.17 for live birth rate; 8.3% versus 9.5%, aOR 0.82, 95% CI 0.63-1.07 for miscarriage rate). Cycles with low D3 cell number (five cells or fewer) had significantly higher miscarriage rate (9.2% versus 7.6%, aOR 1.33, 95% CI 1.02-1.75) compared with cycles with eight cells on D3. CONCLUSIONS Poor-quality cleavage embryos should be cultivated to the blastocyst stage because high-quality blastocysts derived from poor-grade D3 embryos had acceptable pregnancy outcomes. When the blastocyst grade is identical, choosing embryos with higher D3 cell number (eight or more cells) for transfer could reduce the risk of early miscarriage.
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Affiliation(s)
- Jiaxin Qiu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tong Du
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Guo
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, The School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Zhao
- Department of Obstetrics and Gynaecology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wentao Li
- Department of Obstetrics and Gynaecology, The School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- JC School of Public Health and Primary Care The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
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12
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Chang H, Ge H, Wu Q, Li J, Zhang Y, Zhu M, Luo X, Han Y, Wang Y, Wang CC, Wu X. Is elevated baseline SHBG associated with increased ovulation? Gynecol Endocrinol 2023; 39:2263085. [PMID: 37913814 DOI: 10.1080/09513590.2023.2263085] [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] [Received: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Sexual hormone binding globulin (SHBG) is associated with the endocrine and reproductive systems. We aimed to investigate the role of SHBG in the reproductive process. Therefore, we conducted a secondary analysis of the PCOSAct (Polycystic Ovary Syndrome and Acupuncture Clinical Trial) study, which involved 21 sites in China and a total of 1000 women with PCOS. Out of these, 954 women with SHBG were included in the analysis. Through multivariate analysis of ovulation predictors, we found that age, BMI, estradiol, testosterone, and SHBG all showed a positive predictive value for ovulation (p = 0.0211, 0.0011, 0.0211, 0.0029, 0.0434, respectively). However, the LH to FSH ratio had a negative predictive value (p = 0.0539). Higher quartiles of SHBG were associated with a higher rate of ovulation, and per quartile increased was statistically significant (HR = 1.138, 95%CI [1.054,1.229]). The association remained significant even after adjusting for testosterone (HR = 1.263, 95%CI [1.059, 1.507]). On the other hand, quartiles of testosterone and estradiol did not exhibit any significant tendency toward ovulation. SHBG demonstrated predictive ability for ovulation, conception, pregnancy, and live birth (p < 0.05), and this correlation remained significant after adjusting intervention. Kaplan-Meier curves illustrated that increased levels of SHBG were a factor in high rates of ovulation, conception, and pregnancy. In comparison to other sexual hormones, a higher baseline level of SHBG was related to increased ovulation.
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Affiliation(s)
- Hui Chang
- Department of Gynecology I, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Hang Ge
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qi Wu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong kong, China
| | - Jian Li
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yanli Zhang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Mengyi Zhu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xi Luo
- Department of Obstetrics and Gynecology, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanhua Han
- Department of Gynecology I, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yong Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong kong, China
| | - Xiaoke Wu
- Department of Gynecology I, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
- Centre for Reproductive Medicine, Heilongjiang Provincial Hospital, Harbin,China
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13
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Muneeba S, Acharya N, Mohammad S. The Role of Dydrogesterone in the Management of Luteal Phase Defect: A Comprehensive Review. Cureus 2023; 15:e48194. [PMID: 38050524 PMCID: PMC10693668 DOI: 10.7759/cureus.48194] [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: 08/26/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
The luteal phase of the menstrual cycle is a pivotal period characterized by hormonal intricacies that lay the foundation for successful embryo implantation and early pregnancy development. Luteal phase defect (LPD), marked by abnormalities in luteal function, presents challenges that can impede reproductive outcomes. This comprehensive review article explores the role of dydrogesterone in LPD management, elucidating its mechanisms of action, evidence of efficacy, safety profile, and potential in combination therapies. Dydrogesterone, a synthetic progestogen, closely mirrors natural progesterone's actions, effectively supplementing the luteal phase and enhancing endometrial receptivity. Clinical studies demonstrate improved pregnancy rates, extended luteal phase support, and enhanced reproductive outcomes with dydrogesterone supplementation. Its favorable safety profile, minimal side effects, and reduced risk of unwanted hormonal effects contribute to its appeal. Furthermore, dydrogesterone's inclusion in international guidelines solidifies its importance in LPD management. Combination therapies, leveraging synergistic effects, offer a comprehensive approach. As gaps in knowledge persist, future research directions and personalized treatment strategies pave the way for a future where dydrogesterone stands as a beacon of hope in conquering the challenges of LPD and achieving successful reproductive outcomes.
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Affiliation(s)
- Shaikh Muneeba
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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14
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Mei Y, Wang Y, Ke X, Liang X, Lin Y, Wang F. Does endometrial receptivity array improve reproductive outcomes in euploid embryo transfer cycles? a systematic review. Front Endocrinol (Lausanne) 2023; 14:1251699. [PMID: 37964969 PMCID: PMC10641275 DOI: 10.3389/fendo.2023.1251699] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/22/2023] [Indexed: 11/16/2023] Open
Abstract
Besides chromosomal normality, endometrial receptivity is an important factor in determining successful pregnancies. Endometrial receptivity array (ERA), a promising endometrial receptivity test, was speculated to improve the reproductive outcomes. However, its effectiveness is controversial in clinical practice. Therefore, we conducted this review to investigate its role in in vitro fertilization (IVF) treatment. To eliminate the interference of embryo quality, we only analyzed studies that originally reported the reproductive outcomes of patients who underwent ERA-guided euploid embryo transfer (EET). Unexpectedly, it revealed that ERA could not optimize the reproductive outcomes in EET cycles, no matter in general infertile population or in patients with a history of previous failed embryo transfers.
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Affiliation(s)
| | | | | | | | - Yonghong Lin
- Department of Reproduction and Infertility, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fang Wang
- Department of Reproduction and Infertility, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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15
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Zimmermann JSM, Ramisch P, Radosa MP, Radosa CG, Kaya AC, Brucker SY, Taran FA, Ulrich UA, Hackethal A, Deeken M, Sütterlin M, Tuschy B, Solomayer EF, Radosa JC. Laparoscopic Fertility-Sparing Surgery for Early Ovarian Malignancies. Cancers (Basel) 2023; 15:5099. [PMID: 37894466 PMCID: PMC10605175 DOI: 10.3390/cancers15205099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The demand for fertility-sparing surgery (FSS) has increased in the last decade due to increased maternal age, increased incidence of ovarian malignancies in younger patients, and technical advances in surgery. Data on oncological safety and fertility outcomes of patients with ovarian cancer after laparoscopic FSS are sparse, but some retrospective studies have shown that open FSS may be offered to selected patients. We assessed the role of minimally invasive FSS in comparison with radical surgery (RS) in terms of oncological safety and reproductive outcomes after FSS in this multicenter study. Eighty patients with FIGO stage I/II ovarian cancer treated with laparoscopic FSS or RS between 01/2000 and 10/2018 at the participating centers (comprehensive gynecological cancer centers with minimally invasive surgical expertise) were included in this retrospective analysis of prospectively kept data. Case-control (n = 40 each) matching according to the FIGO stage was performed. Progression-free survival [150 (3-150) and 150 (5-150) months; p = 0.61] and overall survival [36 (3-150) and 50 (1-275) months; p = 0.65] did not differ between the FSS and RS groups. Eight (25.8%) women became pregnant after FSS, resulting in seven (22.5%) deliveries; three (37.5%) patients conceived after in vitro fertilization, and five (62.5%) conceived spontaneously. Laparoscopic FSS seems to be applicable and oncologically safe for patients with early-stage ovarian cancer, with adequate fertility outcomes.
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Affiliation(s)
- Julia S. M. Zimmermann
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany; (J.S.M.Z.)
| | - Pauline Ramisch
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany; (J.S.M.Z.)
| | - Marc P. Radosa
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany; (J.S.M.Z.)
- Department of Gynecology and Obstetrics, Klinikum Bremen Nord, D-28755 Bremen, Germany
| | - Christoph G. Radosa
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, D-01307 Dresden, Germany
| | - Askin C. Kaya
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany; (J.S.M.Z.)
| | - Sara Y. Brucker
- Department of Gynecology, Tübingen University Hospital, D-72076 Tübingen, Germany
| | - Florin A. Taran
- Department of Gynecology, University Medical Center Freiburg, D-79106 Freiburg, Germany
| | - Uwe A. Ulrich
- Department of Gynecology, Martin Luther Hospital, Johannesstift Diakonie, D-14193 Berlin, Germany
| | | | - Martin Deeken
- Department of Gynecology, D-66346 Püttlingen, Germany
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, D-68167 Mannheim, Germany
| | - Benjamin Tuschy
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, D-68167 Mannheim, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany; (J.S.M.Z.)
| | - Julia C. Radosa
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany; (J.S.M.Z.)
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16
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Li QL, Wang C, Cao KX, Zhang L, Xu YS, Chang L, Liu ZH, Yang AJ, Xue YX. Sleep characteristics before assisted reproductive technology treatment predict reproductive outcomes: a prospective cohort study of Chinese infertile women. Front Endocrinol (Lausanne) 2023; 14:1178396. [PMID: 37908752 PMCID: PMC10614022 DOI: 10.3389/fendo.2023.1178396] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/06/2023] [Indexed: 11/02/2023] Open
Abstract
Sleep disorders affect mental and physical health. Infertile women undergoing assisted reproductive technology (ART) treatment are prone to sleep disorders. Sleep condition, its influencing factors, and the association between sleep condition and ART treatment outcomes before treatment have not been explored within a population with a large sample size. Therefore, we investigated the sleep characteristics of 1002 Chinese infertile women before ovulation induction and investigated the influencing factors (negative and positive psychological factors, demographics, and fertility characteristics). We also examined whether sleep conditions before treatment predicted reproductive outcomes. We found that 24.1% of participants reported poor sleep quality. Women with primary infertility reported poorer sleep than women with secondary infertility. Negative psychological factors, including depression, anxiety, and perceived stress were associated with poor sleep, whereas positive affect was linked with good sleep. Adverse sleep characteristics, including poor subjective sleep quality, sleep disturbances, and poor sleep efficiency, decreased the quantity and quality of oocytes retrieved, fertilization rates, and clinical pregnancy rates. This study indicates that before ART treatment, a large number of females with infertility suffer from sleep problems, which are affected by psychological factors and infertility type, and unhealthy sleep characteristics may impair treatment outcomes. Our findings highlight the importance of screening and treatment for sleep disorders before the enrollment of ART treatment in infertile women.
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Affiliation(s)
- Qian-Ling Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Chao Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, China
| | - Ke-Xin Cao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Lin Zhang
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yun-Shuai Xu
- Department of Psychiatry, Shandong Daizhuang Hospital, Jining, China
| | - Liang Chang
- Henan Key Laboratory of Medical Tissue Regeneration, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Zhen-Hui Liu
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ai-Jun Yang
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, China
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17
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Mohanty G, Tourzani DA, Gervasi MG, Houle E, Oluwayiose O, Suvorov A, Richard Pilsner J, Visconti PE. Effects of preconception exposure to phthalates on mouse sperm capacitation parameters. Andrology 2023; 11:1484-1494. [PMID: 36891737 PMCID: PMC11004914 DOI: 10.1111/andr.13423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/04/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Phthalates have been linked to adverse male reproductive health, including poor sperm quality and embryo quality as well as a longer time to pregnancy (months of unprotected intercourse before conception occurs). The present study aimed to evaluate the effect of preconception exposure to two ubiquitous phthalate chemicals, di(2-ethylhexyl) phthalate (DEHP), di-n-butyl phthalate (DBP), and their mixture on sperm function, fertilization, and embryo development in mice. MATERIALS AND METHODS Adult male C57BL/6J mice aged 8-9 weeks were exposed to di(2-ethylhexyl) phthalate, di-n-butyl phthalate, or their mixture (di-n-butyl phthalate + di(2-ethylhexyl) phthalate) at 2.5 mg/kg/day or vehicle for 40 days (equivalent to one spermatogenic cycle) via surgically implanted osmotic pumps. Caudal epididymal spermatozoa were extracted and analyzed for motility using computer-assisted sperm analyses. Sperm phosphorylation of protein kinase A substrates and tyrosine phosphorylation, markers of early and late capacitation events, respectively, were analyzed by Western blots. In vitro fertilization was used to evaluate the sperm fertilizing capacity. RESULTS While the study did not reveal any significant differences in sperm motility and fertilization potential, abnormal sperm morphology was observed in all phthalate exposures, particularly in the phthalate mixture group. In addition, the study revealed significant differences in sperm concentration between control and exposed groups. Moreover, protein phosphorylation of protein kinase A substrates was decreased in the di(2-ethylhexyl) phthalate and mixture exposure groups, while no significant changes in protein tyrosine phosphorylation were observed in any of the groups. Assessment of the reproductive functionality did not reveal significant effects on in vitro fertilization and early embryo development rates but showed wide variability in the phthalate mixture group. CONCLUSION Our findings suggest that preconception phthalate exposure affects sperm numbers and phosphorylation of protein kinase A substrates involved in capacitation. Future research is warranted to examine the associations between phthalate exposure and capacitation in human spermatozoa.
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Affiliation(s)
- Gayatri Mohanty
- Department of Veterinary and Animal Sciences, Integrated Sciences Building, University of Massachusetts, Amherst, USA
| | - Darya A. Tourzani
- Department of Veterinary and Animal Sciences, Integrated Sciences Building, University of Massachusetts, Amherst, USA
| | - María G. Gervasi
- Department of Veterinary and Animal Sciences, Integrated Sciences Building, University of Massachusetts, Amherst, USA
| | - Emily Houle
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Oladele Oluwayiose
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Alexander Suvorov
- Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - J. Richard Pilsner
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Pablo E. Visconti
- Department of Veterinary and Animal Sciences, Integrated Sciences Building, University of Massachusetts, Amherst, USA
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Nagulapalli A, Vembu R, Pandurangi M, Nellepalli SR. Luteinizing Hormone/Human Chorionic Gonadotropin Receptor N312S Single-Nucleotide Polymorphism and Its Impact on Clinical and Reproductive Outcomes in Assisted Reproductive Technology: A Prospective Cohort Study. Cureus 2023; 15:e47217. [PMID: 38022167 PMCID: PMC10652146 DOI: 10.7759/cureus.47217] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The aim of this study was to determine the genotypic distribution of luteinizing hormone/human chorionic gonadotropin receptor (LHCGR) N312S single-nucleotide polymorphism (SNP) and to investigate its impact on clinical and reproductive outcomes in infertile Indian women undergoing assisted reproductive technology (ART). Study design and settings This was a prospective cohort study conducted at a tertiary care university hospital. Subjects and methods Infertile women aged between 21 and 40 years undergoing ART with an antagonist protocol were enrolled in this study. A 2-ml sample of peripheral venous blood was collected from each woman and genotyped for the LHCGR N312S SNP. Participants were divided into three groups based on their SNP: NN, NS, and SS. All subjects underwent controlled ovarian hyperstimulation (COH) through a gonadotropin-releasing hormone (GnRH) antagonist protocol and intracytoplasmic sperm injection (ICSI). Of the 140 women recruited based on selection criteria, 128 underwent embryo transfer. We compared the genotypic distribution of the LHCGR N312S SNP, baseline characteristics, clinical outcomes, and reproductive outcomes in ART among the three groups. Data were analyzed using IBM SPSS Statistics for Windows, Version 29 (Released 2022; IBM Corp., Armonk, New York, United States). The chi-square test and Fisher-Irwin test were employed to evaluate significant differences among the qualitative categorical variables. A p-value of less than 0.05 was considered statistically significant. Results Among the test subjects, 19.3% were homozygous for the LHCGR N312 SNP (NN group), 38.6% were heterozygous (NS group), and 42.1% were homozygous for the LHCGR S312 SNP (SS group). Baseline characteristics were similar among the three groups. In terms of ovarian reserve tests, significantly lower anti-Müllerian hormone (AMH) levels were observed in the SS group compared to the NS and NN groups (2.8 ± 2.1 vs. 3.2 ± 2.5 vs. 4.3 ± 3.3; p=0.03). No significant differences were observed in COH outcomes such as duration of stimulation, total gonadotropin requirement, oocyte yield, or the number of good-quality embryos among the three groups. The cumulative pregnancy rate (82.9% vs. 50.0% vs. 38.2%, p=0.0005), cumulative clinical pregnancy rate (78.8% vs. 44.7% vs. 34.5%, p = 0.0005), and cumulative live birth rate (50.0% vs. 20.2% vs. 20.0%, p=0.005) were significantly higher in the NN group than in the NS and SS groups. Conclusion The study's findings suggest that LHCGR N312 may help predict reproductive outcomes in ART, which may aid in providing better counseling to infertile couples. We need more studies on individualized/personalized COH using pharmacogenomics for follicle-stimulating hormone (FSH) and luteinizing hormone (LH) supplementation based on combined FSH and LH receptor SNP and to assess their effects on ART outcomes.
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Affiliation(s)
- Amulya Nagulapalli
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Radha Vembu
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Monna Pandurangi
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sanjeeva R Nellepalli
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Papanikolaou E, Peitsidis N, Tsakiridis I, Michos G, Skalias A, Patoulias D, Poutoglidis A, Mamopoulos A, Athanasiadis A, Grimpizis G, Najdecki R. Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis. Front Surg 2023; 10:1225111. [PMID: 37795147 PMCID: PMC10546045 DOI: 10.3389/fsurg.2023.1225111] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Objective Endometrial scratching (ES) during hysteroscopy before embryotransfer (ET) remains doubtable on whether it benefits the reproductive outcomes. The optimal technique is not clear and repeated implantation failure as a challenging field in in vitro fertilization (IVF) seems to be the springboard for clinicians to test its effectiveness. Methods Medline, PMC, ScienceDirect, Scopus, CENTRAL, Google Scholar were searched from their inception up to April 2023 for studies to evaluate the effectiveness of adding endometrial scratching during hysteroscopy before ET. Results The initial search yielded 959 references, while 12 eligible studies were included in the analyses, involving 2,213 patients. We found that hysteroscopy and concurrent ES before ET resulted in a statistically significant improvement in clinical pregnancy rate (CPR) [RR = 1.50, (95% CI 1.30-1.74), p < 0.0001] and live birth rate (LBR) [RR = 1.67, (95% CI 1.30-2.15), p < 0.0001] with no statistically significant difference on miscarriage rate [RR = 0.80 (95% CI 0.52-1.22), p = 0.30]. Conclusion Our meta-analysis suggests that hysteroscopy with concurrent ES may be offered in IVF before ET as a potentially improving manipulation. Future randomized trials comparing different patient groups would also provide more precise data on that issue, to clarify specific criteria in the selection of patients. Systematic Review Registration PROSPERO (CRD42023414117).
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Affiliation(s)
| | - Nikolaos Peitsidis
- Assisting Nature IVF Centre and Genetics, Thessaloniki, Greece
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Michos
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Skalias
- 2nd Academic Otorhinolaryngology, Head and Neck Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Patoulias
- Department of Obstetrics and Gynaecology, Interbalkan Hospital, Thessaloniki, Greece
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology, Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios Grimpizis
- 1st Department of Obstetrics and Gynaecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Najdecki
- Assisting Nature IVF Centre and Genetics, Thessaloniki, Greece
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Colombo T, Hentschke MR, Badalotti M, Kira ATF, Telöken IB, Trindade VD, Dornelles VC, Petracco A, Wendland EM. A sharing oocyte donation program: a 15-year cohort stud. JBRA Assist Reprod 2023; 27:348-354. [PMID: 37134011 DOI: 10.5935/1518-0557.20220056] [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] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To evaluate clinical and laboratory outcomes of oocyte donation cycles and compare the results from donors and recipients. METHODS A retrospective cohort study was conducted at a reproductive medicine center. A 586 first fresh oocyte donation cycles, performed from 01/2002 to 12/2017 were included. The outcomes of 290 cycles from donors and 296 from recipients, resulting in 473 fresh embryo transfers, were analyzed. The oocyte division was equally made, whereas, at an odd amount, the donor always had a preference. The data were collected from an electronic database, and analyzed using Chi-square test, Fisher's exact test, Mann-Whitney U-test or Student t-test depending on the data distribution, and multivariate logistic regression, considering p<0.05. RESULTS The main results comparing donor and recipient, were, respectively: fertilization rate (72.0±21.4 vs. 74.6±24.2, p<0.001), implantation rate (46.2% vs. 48.5%, p=0.67); clinical pregnancy rate (41.9% vs. 37.7%, p=0.39), live birth rates by transfer (33.3 vs. 37.7, p=0.54). CONCLUSIONS Oocyte donation is often the way donors can access in vitro fertilization, and for recipients seems to be a good option for pregnancy. Demographic and clinical characteristics have a secondary role in oocyte donors under 35 years and patient without comorbidities under 50 years and were not associated with pregnancy outcomes, emphasizing the power of oocyte quality on the success of intracytoplasmic sperm injection treatment. An oocyte-sharing program that offers good and comparable results is fair and worth being encouraged.
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Affiliation(s)
- Talita Colombo
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Fertilitat Reproductive Medicine Center, Porto Alegre, Brazil
| | - Marta Ribeiro Hentschke
- Fertilitat Reproductive Medicine Center, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mariangela Badalotti
- Fertilitat Reproductive Medicine Center, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Isadora Badalotti Telöken
- Fertilitat Reproductive Medicine Center, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vanessa Devens Trindade
- Fertilitat Reproductive Medicine Center, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Victoria Campos Dornelles
- Fertilitat Reproductive Medicine Center, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alvaro Petracco
- Fertilitat Reproductive Medicine Center, Porto Alegre, Brazil
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Cang W, Liang C, Wang D, Xue X, Cao D, Yang J, Pan L, Wu M, Yang J, Xiang Y. Oncological and Reproductive Outcomes after Fertility-Sparing Surgery in Patients with Advanced-Stage Serous Borderline Ovarian Tumor: A Single-Center Retrospective Study. J Clin Med 2023; 12:5827. [PMID: 37762767 PMCID: PMC10531562 DOI: 10.3390/jcm12185827] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/06/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Our study aimed to analyze the prognosis and reproductive outcomes of patients with advanced-stage serous borderline ovarian tumors (SBOTs) who underwent fertility-sparing surgery (FSS). This study included patients aged ≤ 45 years diagnosed with advanced-stage (International Federation of Gynecology and Obstetrics II and III) SBOTs who were treated with FSS. Conservative surgeries were performed in 65 patients with advanced-stage SBOT with a median age of 28 years (range, 16-44 years). Nine patients had invasive implants. The median follow-up was 81.7 months. Forty-six patients (70.8%) had a relapse (median time to first recurrence, 22.8 months). Thirteen patients subsequently developed recurrence as an invasive disease, and two died due to disease progression. After multivariate analysis, age < 30 years and incomplete cytoreduction were independent risk factors for recurrence. Invasive implants and postoperative residual tumors were significantly associated with shorter disease-free survival. Of 35 patients attempting to conceive, 12 underwent assisted reproductive technology. Additionally, 19 pregnancies, including 15 full-term births, were documented. FSS provides a good chance of reproductive success in women with advanced-stage SBOT who desire fertility preservation, but it has a high recurrence rate and risk of malignancy transformation. Patients with invasive implants should be strictly selected for FSS.
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Affiliation(s)
- Wei Cang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
| | - Chao Liang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
| | - Dan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
| | - Xiaowei Xue
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China
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La Marca A, Donno V, Longo M, Greco P, Cucinelli F, Varricchio MT, Listorti I, Greco E. Predicting the total number of retrieved oocytes following double ovarian stimulation (DuoStim). Hum Reprod 2023; 38:1784-1788. [PMID: 37470235 DOI: 10.1093/humrep/dead148] [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: 02/22/2023] [Revised: 06/16/2023] [Indexed: 07/21/2023] Open
Abstract
STUDY QUESTION Can anti-Müllerian hormone (AMH) help predict how many oocytes will be retrieved following double stimulation (DuoStim)? SUMMARY ANSWER A simple clinical tool can use serum AMH values to predict ovarian response following DuoStim in IVF cycles. WHAT IS ALREADY KNOWN The knowledge that multiple follicular waves arise during a single ovarian cycle has led to the introduction of unconventional ovarian stimulation protocols. The DuoStim protocol involves two successive ovarian stimulations performed during a single ovarian cycle and has been proposed as an approach for patients with poor ovarian response and for medical fertility preservation. As AMH has been used as a marker of ovarian reserve and stimulation response, the current study aimed to investigate the diagnostic performance of AMH in predicting the number of retrieved oocytes following DuoStim. STUDY DESIGN, SIZE, DURATION This is a retrospective observational study involving 116 patients who received IVF treatment from January 2021 to September 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was conducted at a private IVF centre. Only patients who had their AMH measured prior to treatment and had complete patient records regarding their clinical and IVF/ICSI cycle characteristics were included. The primary outcome was the correlation between AMH values and the number of oocytes retrieved following DuoStim. Parametric and non-parametric tests were used to compare baseline characteristics and outcomes. Spearman's R was used to analyse correlations between variables, while the C statistic was used to calculate the diagnostic performance of AMH. MAIN RESULTS AND THE ROLE OF CHANCE AMH levels were significantly correlated with the total number of oocytes retrieved after the DuoStim (R 0.61; CI 0.44-0.70; P < 0.0001). The difference in the total number of oocytes retrieved between the first (median 4 oocytes, interquartile range (IQR) 2-6) and second (median 6 oocytes, IQR 3.2-8) stimulation was statistically significant (P < 0.0001). However, there was no significant difference in the number of mature oocytes that were retrieved (median of 3 and 4 in the first and second stimulations, respectively). After the first stimulation, 68% of patients had at least one blastocyst available, while after the second stimulation, 74% did (NS). Based on linear regression, each 0.25 ng/ml increase in basal AMH corresponds to one additional oocyte recovered at the end of both stimulations (R2: 0.32, P < 0.0001). LIMITATIONS, REASONS FOR CAUTION The results are limited owing to the observational nature of the study and the number of participants. WIDER IMPLICATIONS OF THE FINDINGS Counselling infertile couples regarding the intermediate outcome of IVF (i.e. number of retrieved oocytes) is one of the most demanding tasks that clinicians face. To our knowledge, this is the first study that provides an easy-to-use clinical tool that enables the quantitative prediction of ovarian response following DuoStim, based on serum AMH values. STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A La Marca
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - V Donno
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - M Longo
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - P Greco
- Reproductive Medicine, Villa Mafalda, Rome, Italy
| | - F Cucinelli
- Department of Obstetrics and Gynecology, San Camillo Hospital, Rome, Italy
| | | | - I Listorti
- Reproductive Medicine, Villa Mafalda, Rome, Italy
| | - E Greco
- Reproductive Medicine, Villa Mafalda, Rome, Italy
- UniCamillus, International Medical University, Rome, Italy
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Génard-Walton M, Warembourg C, Duros S, Ropert-Bouchet M, Lefebvre T, Guivarc'h-Levêque A, Le Martelot MT, Jacquemin B, Cordier S, Costet N, Multigner L, Garlantézec R. Heavy metals and diminished ovarian reserve: single-exposure and mixture analyses amongst women consulting in French fertility centres. Reprod Biomed Online 2023; 47:103241. [PMID: 37451971 DOI: 10.1016/j.rbmo.2023.05.013] [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: 01/09/2023] [Revised: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
RESEARCH QUESTION Do heavy metals affect the risk of diminished ovarian reserve (DOR) in women of reproductive age? DESIGN A total of 139 cases and 153 controls were included between 2016 and 2020. The participants were aged between 18 and 40 years and attended consultations for couple infertility in one of four fertility centres in western France. Cases of DOR were defined as women with an antral follicle count less than 7, anti-Müllerian hormone levels 1.1 ng/ml or less, or both. Controls were frequency matched on age groups and centres, and were women with normal ovarian reserve evaluations, no malformations and menstrual cycles between 26 and 35 days. Heavy metals (lead, mercury, cadmium and chromium) were measured in whole blood at inclusion. Single-exposure associations were examined with multivariable logistic regressions adjusted on potential confounders. Mixture effects were investigated with quantile g-computation and Bayesian kernel machine regression (BKMR). RESULTS Chromium as a continuous exposure was significantly associated with DOR in unadjusted models (OR 2.07, 95% CI 1.04 to 4.13) but the association was no longer significant when confounders were controlled for (adjusted OR 2.75, 95% CI 0.88 to 8.60). Similarly, a statistically significant association was observed for the unadjusted second tercile of cadmium exposure (OR 1.87, 95% CI 1.06 to 3.30); however, this association was no longer statistically significant after adjustment. None of the other associations tested were statistically significant. Quantile g-computation and BKMR both yielded no significant change of risk of DOR for the mixture of metals, with no evidence of interaction. CONCLUSIONS Weak signals that some heavy metals could be associated with DOR were detected. These findings should be replicated in other studies.
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Affiliation(s)
- Maximilien Génard-Walton
- Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France.
| | - Charline Warembourg
- Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Solène Duros
- Reproductive Medicine, CHU Rennes, 35200 Rennes, France
| | | | | | | | | | - Bénédicte Jacquemin
- Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Sylvaine Cordier
- Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Nathalie Costet
- Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Luc Multigner
- Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Ronan Garlantézec
- Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
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Kaluanga Bwanga P, Tremblay-Lemoine PL, Timmermans M, Ravet S, Munaut C, Nisolle M, Henry L. The Endometrial Microbiota: Challenges and Prospects. Medicina (Kaunas) 2023; 59:1540. [PMID: 37763663 PMCID: PMC10534531 DOI: 10.3390/medicina59091540] [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] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Contrary to popular belief, we have known for many years that the endometrium is not a sterile environment and is considered to be a low-biomass milieu compared to the vagina. Numerous trials and studies have attempted to establish a valid sampling method and assess its physiological composition, but no consensus has been reached. Many factors, such as ethnicity, age and inflammation, can influence the microbiome. Moreover, it possesses a higher alpha-diversity and, therefore, contains more diverse bacteria than the vagina. For instance, Lactobacillus has been shown to be a predominant genus in the vaginal microbiome of healthy women. Consequently, even if a majority of scientists postulate that a predominance of Lactobacillus inside the uterus improves reproductive outcomes, vaginal contamination by these bacteria during sampling cannot be ruled out. Certain pathologies, such as chronic endometritis, have been identified as inflammation perpetrators that hinder the embryo implantation process. This pro-inflammatory climate created by dysbiosis of the endometrial microbiota could induce secondary inflammatory mediators via Toll-like receptors, creating an environment conducive to the development of endometriosis and even promoting carcinogenesis. However, studies to this day have focused on small populations. In addition, there is no clearly defined healthy uterine composition yet. At most, only a few taxa have been identified as pathogenic. As sampling and analysis methods become increasingly precise, we can expect the endometrial microbiota to be incorporated into future diagnostic tools and treatments for women's health.
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Affiliation(s)
| | - Pierre-Luc Tremblay-Lemoine
- Department of Obstetrics and Gynecology, CHU of Liege-Citadelle Site, University of Liège, 4000 Liège, Belgium
| | - Marie Timmermans
- Department of Obstetrics and Gynecology, CHU of Liege-Citadelle Site, University of Liège, 4000 Liège, Belgium
| | - Stéphanie Ravet
- Center for Reproductive Medicine, University of Liège-Citadelle Site, 4000 Liege, Belgium
| | - Carine Munaut
- Laboratory of Tumor and Development Biology, Giga-Cancer, University of Liège, 4000 Liège, Belgium
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, CHU of Liege-Citadelle Site, University of Liège, 4000 Liège, Belgium
| | - Laurie Henry
- Department of Obstetrics and Gynecology, CHU of Liege-Citadelle Site, University of Liège, 4000 Liège, Belgium
- Center for Reproductive Medicine, University of Liège-Citadelle Site, 4000 Liege, Belgium
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Alam F, Khan AH, Baig M, Rehman R. Editorial: Recent advances in vitamin D supplementation for improved reproductive endocrine and metabolic parameters. Front Endocrinol (Lausanne) 2023; 14:1251388. [PMID: 37664848 PMCID: PMC10471959 DOI: 10.3389/fendo.2023.1251388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Faiza Alam
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Bagawan, Brunei
| | - Aysha Habib Khan
- Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Mukhtiar Baig
- Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rehana Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Kimelman D, Torrens A, Bonelli C, Sapiro R. Fertility preservation in male cancer patients. Counseling and reproductive outcomes. Front Cell Dev Biol 2023; 11:1240152. [PMID: 37664467 PMCID: PMC10468982 DOI: 10.3389/fcell.2023.1240152] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction: Advances in cancer treatments have determined an increase in survival rates. However, these lifesaving therapies may have a negative impact on reproductive health. To diminish the infertility risk; different fertility preservation strategies have been designed. Sperm freezing is the gold standard fertility preservation method in the case of post-pubertal men. The main objective of this study is to evaluate the fertility status of Uruguayan male cancer survivors who have gone through sperm freezing, as well as to assess oncofertility counseling received by these patients. Methods: This is a descriptive, cross-sectional, observational, and transversal study. A survey was conducted on male cancer survivors who cryopreserved sperm between 1985 and 2021 in "Reprovita Lab and Biobank" which is the only sperm bank in this country. Results: One hundred thirty-five participants answered the survey. At the time of diagnosis, the mean age of patients was 28.8 ± 6.4 years old. Testicular was the most frequent type of cancer (64%). Only, 12% (n = 15) already had children at the time of diagnosis. Among the interviewed survivors, 50% (n = 62) attempted to conceive after cancer treatment, and 68% (n = 42) achieved natural pregnancy. Patients who did not achieve spontaneous conception (n = 11), used their cryopreserved samples, and 45.4% achieved pregnancy. About 86% (n = 107) of survivors believed that the timing of oncofertility referrals was appropriate and 97% considered that having the possibility of protecting their fertility was very important. Eighty percent (n = 101), were advised by their attending physicians, 14% (n = 18) sought advice from family members or friends, and 4% (n = 5) from oncofertility specialists. Discussion: To our knowledge, this is the first study evaluating the reproductive outcomes of male cancer survivors in our country and the region. Most of the interviewed survivors considered fertility preservation as a positive initiative, independent of their reproductive outcomes, reflecting the importance of fertility preservation counseling as one of the most important aspects for futurequality of life of young cancer patients.
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Affiliation(s)
- Dana Kimelman
- Oncofertility Program, Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado (ASSE), Montevideo, Uruguay
- Reprovita Lab and Biobank, Montevideo, Uruguay
- Clínica Ginecotocológica “B”, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | | | | | - Rossana Sapiro
- Unidad Académica Histologia y Embriologia, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Bayar E, Saso S, Galazis N, Jones B, Bracewell-Milnes T, Chawla M, Ahmed-Salim Y, Nagi JB. Impact of polyunsaturated fatty acid supplementation on assisted reproductive technology outcomes: a systematic review. HUM FERTIL 2023; 26:678-686. [PMID: 34906024 DOI: 10.1080/14647273.2021.2007421] [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: 02/25/2021] [Accepted: 08/30/2021] [Indexed: 10/19/2022]
Abstract
This review explores the impact of polyunsaturated fatty acid (PUFA) supplementation in women undergoing assisted reproductive technology (ART) on reproductive outcomes. A systematic search of English peer-reviewed journals was carried out using MEDLINE, EMBASE, and the Cochrane Library to identify articles published from January 1978 to 2021. The primary outcomes assessed included pregnancy and live birth rates. Secondary outcome measures included: (i) implantation rate; (ii) fertilisation rate; (iii) number of oocytes retrieved; (iv) number of metaphase II (MII) oocytes; (v) blastocyst conversion; and (vi) embryo quality. A total of 4 randomised control trials (RCTs) met the inclusion criteria. There is a lack of high-quality research to support widespread dietary supplementation with PUFAs in women undergoing ART. Prior to its clinical recommendation, there is a need for well-designed RCTs to facilitate an in-depth understanding of PUFA supplementation in women undergoing ART.
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Affiliation(s)
- Erna Bayar
- Imperial College NHS Healthcare Trust, Queen Charlotte's Hospital, London, UK
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
| | - Srdjan Saso
- Imperial College NHS Healthcare Trust, Queen Charlotte's Hospital, London, UK
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
| | - Nicolas Galazis
- Obstetrics and Gynaecology Department, Northwick Park NHS Trust, London, UK
| | - Benjamin Jones
- Imperial College NHS Healthcare Trust, Queen Charlotte's Hospital, London, UK
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
| | | | - Mehar Chawla
- Obstetrics & Gynaecology Department, North Middlesex University Hospital, London, UK
| | - Yousra Ahmed-Salim
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Jara Ben Nagi
- The Centre for Reproductive and Genetic Health, London, UK
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Dolgushina NV, Menzhinskaya IV, Ermakova DM, Frankevich NA, Vtorushina VV, Sukhikh GT. The Effect of COVID-19 Severity, Associated Serum Autoantibodies and Time Interval after the Disease on the Outcomes of Fresh Oocyte ART Cycles in Non-Vaccinated Patients. J Clin Med 2023; 12:4370. [PMID: 37445405 DOI: 10.3390/jcm12134370] [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: 05/11/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
It is assumed that SARS-CoV-2- and COVID-19-associated autoimmune processes may affect the outcomes of assisted reproductive technology (ART) cycles. This observational prospective study included 240 infertile patients: 105 patients had no history of COVID-19 (group 1) and 135 patients had experienced COVID-19 (group 2) in a mild (n = 85) or moderate (n = 50) form less than 12 months prior to oocyte retrieval. Using ELISAs, the profiles of their serum autoantibodies were determined, including antiphospholipid antibodies and antibodies to nuclear and thyroid antigens. The parameters of oogenesis and embryogenesis, as well as the pregnancy and childbirth rates, did not differ between groups 1 and 2, and also between the subgroups with different severities of COVID-19. However, when oocyte retrieval was performed less than 180 days after COVID-19, a higher proportion of poor-quality blastocysts was obtained (p = 0.006). A high risk of early miscarriage was found in the patients with moderate COVID-19. In group 2, IgG antibodies to annexin V, phosphatidylethanolamine (PE), and TSHr were detected more often than in group 1 (p = 0.035; p = 0.028; and p = 0.033, respectively), and a weak inverse correlation was revealed between anti-PE IgG and the number of oocytes and zygotes obtained. The results of the study suggest a possible adverse effect of COVID-19 and its associated autoantibodies on the outcomes of fresh oocyte ART cycles and early pregnancy, which depends on the severity of COVID-19 and the time interval after the disease.
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Affiliation(s)
- Nataliya V Dolgushina
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia
- Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Federal State Autonomous Educational Institution of Higher Education the First Moscow State Medical University Named after I.M. Sechenov of Ministry of Health of the Russian Federation (Sechenov University), 119048 Moscow, Russia
| | - Irina V Menzhinskaya
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia
| | - Daria M Ermakova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia
| | - Natalia A Frankevich
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia
| | - Valentina V Vtorushina
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia
| | - Gennady T Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia
- Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Federal State Autonomous Educational Institution of Higher Education the First Moscow State Medical University Named after I.M. Sechenov of Ministry of Health of the Russian Federation (Sechenov University), 119048 Moscow, Russia
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Chang Y, Shen M, Wang S, Guo Z, Duan H. Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty. Front Endocrinol (Lausanne) 2023; 14:1063774. [PMID: 37361532 PMCID: PMC10285310 DOI: 10.3389/fendo.2023.1063774] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background Hysteroscopic metroplasty of the uterine septum has been the standard treatment strategy to improve reproductive outcomes, but there are still controversies about the appropriateness of metroplasty. In addition, there have been few studies of the factors related to reproductive outcomes of women after surgery. The study aimed to evaluate the reproductive outcomes and the associated risk factors that influence reproductive outcomes after hysteroscopic metroplasty of women with septate uterus and the desire to conceive. Methods This study was an observational study. Cases were screened by searching electronic patient files, and demographic factors were collected. We conducted telephone follow-ups to collect the postoperative reproductive outcomes. The primary outcome of this study was live birth, and secondary outcomes were ongoing pregnancy, clinical pregnancy, early miscarriage, and preterm birth. Demographic variables included patients' age, body mass index (BMI), the type of septum, infertility and miscarriage history, and complications including intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were collected to perform univariate and multivariate analyses to predict the risk factors of reproductive outcomes after surgery treatment. Results In total, 348 women were evaluated and followed up. There were 95 cases (27.3%, 95/348) with combined infertility, 195 cases (56.0%, 195/348) with miscarriage history, and cases combined with intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were 107 (30.7%, 107/348), 53 (15.2%, 53/348), 28 (8.0%, 28/348), and 5 (1.4%), respectively. Following surgery, the live birth rate and clinical pregnancy rate were significantly higher than prior to surgery (84.6% vs 3.7%, p= 0.000; and 78.2% vs 69.5%, p= 0.01, respectively), early miscarriage rate and preterm delivery rate were significantly lower (8.8% vs 80.6%, p= 0.000; and 7.0% vs 66.7%, p=0.000, respectively). After adjusting for body mass index, miscarriage history, and complications, multivariable logistic regression analysis revealed age ≥ 35 years and primary infertility as independent factors that affected postoperative clinical pregnancy (OR 4.025, 95% CI 2.063-7.851, p= 0.000; and OR 3.603, 95% CI 1.903-6.820, p= 0.000; respectively) and ongoing pregnancy (OR 3.420, 95% CI 1.812-6.455, p= 0.000; and OR 2.586, 95% CI 1.419-4.712, p= 0.002; respectively). Conclusions Hysteroscopic metroplasty could lead to improved reproductive outcomes of women with septate uterus. Both age and primary infertility were independent factors for postoperative reproductive outcomes. Trial registration Chi ECRCT20210343.
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Affiliation(s)
- Yanan Chang
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Minghong Shen
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Sha Wang
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zhengchen Guo
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Hua Duan
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
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Guan W, Dong S, Wang Z, Jiao J, Wang X. Impact of a Lactobacillus dominant cervical microbiome, based on 16S-FAST profiling, on the reproductive outcomes of IVF patients. Front Cell Infect Microbiol 2023; 13:1059339. [PMID: 37305412 PMCID: PMC10250658 DOI: 10.3389/fcimb.2023.1059339] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
Objective This study assessed the impact of the cervical microbiome on reproductive outcomes in frozen embryo transfer (FET) patients. Study design This cross-sectional study included 120 women (aged 20-40 years) undergoing FET. A cervical sample obtained before embryo transfer was analyzed using 16S full-length assembly sequencing technology (16S-FAST), which detects full length 16S rDNA. Results We found that >48% of the identified Lactobacillus species were novel. The cervical microbiome was clustered into three cervical microbiome types (CMT): CMT1, dominated by L. crispatus; CMT2, dominated by L. iners; and CMT3, dominated by other bacteria. CMT1 had a significantly higher biochemical pregnancy rate (P=0.008) and clinical pregnancy rate (P=0.006) than CMT2 and CMT3. Logistic analysis showed that compared to CMT1, CMT2 and CMT3 were independent risk factors for biochemical pregnancy failure (odds ratio [OR]: 6.315, 95% confidence interval [CI]: 2.047-19.476, P=0.001; OR: 3.635, 95% CI: 1.084-12.189, P=0.037) and clinical pregnancy failure (OR: 4.883, 95% CI: 1.847-12.908, P=0.001; OR: 3.478, 95% CI: 1.221-9.911, P=0.020). A L. crispatus-dominated group as a diagnostic indicator of biochemical and clinical pregnancy positive had area under the curve (AUC) values of 0.651(P=0.008) and 0.645(P=0.007), respectively. Combining the cervical microbiome with embryonic stage optimized the diagnostic performance for biochemical and clinical pregnancy failure with AUC values of 0.743(P<0.001) and 0.702(P<0.001), respectively. Additionally, relative abundance of L. crispatus predicted biochemical pregnancy positive with AUC values of 0.679(P=0.002) and clinical pregnancy positive with AUC values of 0.659(P=0.003). Conclusion Cervical microbiome profiling using 16S-FAST enables stratification of the chance of becoming pregnant prior to FET. Knowledge of the cervical microbiota may enable couples to make more balanced decisions regarding the timing and continuation of FET treatment cycles.
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Affiliation(s)
- Wenzheng Guan
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
| | - Sitong Dong
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
| | - Zhen Wang
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
| | - Jiao Jiao
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
| | - Xiuxia Wang
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
- Key Laboratory of Reproductive and Genetic Medicine, China Medical University, National Health Commission, Shenyang, China
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Fan Y, Wu Z, Peng F, Peng H, Liang X, Zhu S. Brief and long co-incubation of sperm and oocytes for in vitro fertilization: a meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth 2023; 23:200. [PMID: 36959550 PMCID: PMC10035113 DOI: 10.1186/s12884-023-05490-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
Background There is still no consensus on the optimal time of oocyte–sperm co-incubation during in vitro fertilization and embryo transfer (IVF-ET). The aim of this meta-analysis was to compare the effects of brief (1-6 h) and long (16-24 h) gametes co-incubation time on IVF outcomes. Methods The study protocol was registered online through PROSPERO (CRD42022337503) and PRISMA guidelines were followed in the present study. The following databases were searched from inception to May 2022 for randomized controlled trials (RCTs): PubMed, Embase, Cochrane library, Web of Science, using search terms related to IVF, gametes, time of co-incubation and reproductive outcome measure. Studies comparing outcomes of brief co-incubation to that of long co-incubation during IVF, and reporting primary outcome (live birth rate), secondary outcomes (clinical pregnancy rate; ongoing pregnancy rate; miscarriage rate; normal fertilization rate; polyspermy rate; top-quality embryo rate; implantation rate) were searched. A total of 11 studies were included in the meta-analysis. Combined odds ratio (OR) and 95% confidence interval (CI) were calculated for the data. Statistical heterogeneity analysis between studies was assessed by Cochran Q and I2 statistic with a significant threshold of P < 0.05. Methodologic quality assessment of RCTs was made for potential risk of bias with Cochrane Risk of Bias Tool. Results Compared to long-term co-incubation, brief co-incubation had an advantage in increasing implantation rate (OR: 1.97, 95% CI: 1.52–2.57), ongoing pregnancy rate (OR: 2.18, 95% CI: 1.44–3.29) and top-quality embryo rate (OR: 1.17, 95% CI: 1.02–1.35). However, brief co-incubation of gametes had no advantages in the live-birth rate (OR: 1.09, 95% CI: 0.72–1.65), miscarriage rate (OR: 1.32, 95% CI: 0.55–3.18), clinical pregnancy rate (OR: 1.36, 95% CI: 0.99–1.87) and polyspermy rate (OR: 0.80, 95% CI: 0.48–1.33) than long-term co-incubation. Additionally, the brief co-incubation was associated with lower normal fertilization rate (OR: 0.89, 95% CI: 0.80–0.99), compared with long co-incubation. Conclusions Brief co-incubation of gametes had the advantages in increasing implantation rate, ongoing pregnancy rate and top-quality embryo rate than long-term co-incubation. However, the live-birth rate displayed no difference between the two in vitro fertilization methods. Gametes co-incubation time should be individualized according to each patient’s IVF history, infertility causes and the semen parameters.
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Affiliation(s)
- Yiyue Fan
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
| | - Zeyu Wu
- grid.449525.b0000 0004 1798 4472The Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong City, Sichuan Province China
| | - Fang Peng
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
| | - Hongyao Peng
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
| | - Xin Liang
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
| | - Shaomi Zhu
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
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He M, Chen Q, He J, Zhao Q, Jiang H, Xia Y. Reproductive outcomes of women with moderate to severe intrauterine adhesions after transcervical resection of adhesion: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33258. [PMID: 36930133 PMCID: PMC10019229 DOI: 10.1097/md.0000000000033258] [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] [Received: 08/16/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Intrauterine adhesions (IUA) refers to the adhesion of the inner wall of the uterus, resulting in complete or partial occlusion of the uterine cavity, which causes a series of symptoms. Transcervical resection of adhesion (TCRA) is the standard surgical method for patients with IUA. However, the recurrence rate of women with moderate to severe IUA is high and it has raised a big concern about the reproductive outcomes. METHODS We conducted a scoping review by using 4 databases, including Google Scholar, PubMed, Scopus, Embase, and web of science, to retrieve relevant literature from September 1, 2001, to February 1, 2023, and to explore the reproductive outcomes in women with moderate to severe IUA after TCRA treatment. Following defined guidelines, data extraction was carried out by 2 researchers, and the findings were examined by 2 senior academics. The papers were evaluated by 2 reviewers using the inclusion and exclusion criteria. Using a form developed especially for this study, pertinent information was retrieved, including the first author, research design, study duration, age, intervention measurement, pregnancy rate, techniques of conception, and live birth rate. Two researchers conducted a quality assessment to determine any potential bias using the Cochrane technique and the Newcastle-Ottawa scale. RevMan 5.4.1 (The Cochrane Collaboration, London, United Kingdom) was used for data analysis, while I2 was used to evaluate heterogeneity. RESULTS In total, this study included 2099 participants. After a detailed systematic review and meta-analyses, the results showed that pregnancy and live birth rates were increased significantly after TCRA, and the risk difference of the pregnancy rate was 1.75 [1.17, 2.62]. Besides, in 2 retrospective studies, the risk difference of live birth rate was 2.26, with a 95% confidence interval of 1.99 to 2.58. Moreover, the menstrual status of women also was improved, and the risk difference of hypermenorrhoea and amenorrhea were -0.28 [-0.37, -0.19] and -0.06 [0.26, 0.13], respectively. CONCLUSIONS Taken together, TCRA is the useful strategy for the treatment of moderate to severe IUA to enhance the reproductive outcomes in women.
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Affiliation(s)
- Meifang He
- Department of Gynecology, Women and Children Healthcare Hospital of Zhuzhou, Zhuzhou, Hunan, China
| | - Qiuli Chen
- Department of Research and Development, Zhejiang Zhongwei Medical Research Center, Hangzhou, Zhejiang, China
| | - Jinlian He
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital of Fuzhou, Fuzhou, Fujian, China
| | - Qingqing Zhao
- Department of Research and Development, Zhejiang Zhongwei Medical Research Center, Hangzhou, Zhejiang, China
| | - Hong Jiang
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital of Fuzhou, Fuzhou, Fujian, China
| | - Yong Xia
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital of Fuzhou, Fuzhou, Fujian, China
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Bedaiwy MA, Fayek B, Yang EC, Iews MS, Elgendi M, Abdelkareem AO, Abdellah AH, Liu YD, Jones A, Mayer U, Abdel Hafez FF. Prevalence, causes, and impact of non-visualized pregnancy losses in a recurrent pregnancy loss population. Hum Reprod 2023; 38:830-839. [PMID: 36881694 DOI: 10.1093/humrep/dead040] [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: 09/29/2022] [Revised: 02/08/2023] [Indexed: 03/09/2023] Open
Abstract
STUDY QUESTION Does the occurrence of non-visualized pregnancy loss (NVPL) affect future reproductive outcomes in patients with recurrent pregnancy loss (RPL)? SUMMARY ANSWER The number of previous NVPLs is a significant predictor of subsequent live birth in patients with RPL. WHAT IS KNOWN ALREADY The number of preceding miscarriages is a strong indicator for future reproductive outcomes. However, NVPL particularly has been sparsely addressed in previous literature. STUDY DESIGN, SIZE, DURATION We performed a retrospective cohort study of 1981 patients attending a specialized recurrent pregnancy loss clinic (RPL) from January 2012 to March 2021. A total of 1859 patients met the inclusion criteria of the study and were included in the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients with a history of RPL, defined as ≥2 pregnancy losses before 20 weeks gestation, who attended a specialized RPL clinic in a tertiary care center were included. Patients' evaluation included parental karyotyping, antiphospholipid antibodies screening, uterine cavity assessment with hysterosalpingography (HSG) or hysteroscopy, maternal thyroid stimulating hormone (TSH) testing, and serum hemoglobin A1C testing. Other investigations were performed only when indicated such as testing for inherited thrombophilias, serum prolactin, oral glucose tolerance test, and endometrial biopsy. Patients were divided into three groups; patients who experienced NVPLs only (pure NVPLs group), patients with only visualized pregnancy losses (pure VPLs group), and patients with history of both NVPLs and VPLs (mixed group). Statistical analysis was performed using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables. Significance was detected when P values <0.05. A logistic regression model was used to determine the impact of NVPLs and VPLs numbers on any live birth subsequent to the initial RPL clinic visit. MAIN RESULTS AND THE ROLE OF CHANCE The prevalence of patients with pure NVPLs, pure VPLs, and mixed losses was 14.7% (274/1859), 31.8% (591/1859), and 53.5% (994/1859), respectively. The prevalence of acquired and congenital uterine anomalies diagnosed by HSG or hysteroscopy was significantly different between pure NVPLs, pure VPLs, and mixed groups (16.8% versus 23.7% versus. 20.7%, respectively P = 0.05). There were no significant differences in the results of other RPL investigations or baseline demographics between the three groups. A logistic regression model controlling for maternal age at the initial RPL clinic visit and the follow-up duration showed that the numbers of NVPLs (odds ratio (OR): 0.77, CI: 0.68-0.88) and VPLs (OR: 0.75, CI: 0.64-0.86) are strong predictors for subsequent live births after the initial RPL clinic visit (P < 0.001). The odds of having a live birth decreased by 23% and 25% with each additional NVPL and VPL, respectively. LIMITATIONS, REASONS FOR CAUTION This study may be limited by its retrospective design. Some of our data, including home pregnancy tests and obstetric history, are based on patient self-reporting, which could have overstated the true prevalence of NVPLs. Another limitation is the lack of available live birth data for all patients at the time of the analysis. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this is the first study to examine and analyze the reproductive outcomes of patients with pure NVPLs in a substantial cohort of patients with RPL. NVPLs seem to affect future live births the same way as clinical miscarriages, which supports their inclusion in RPL definitions. STUDY FUNDING/COMPETING INTEREST(S) This study was supported in part by Canadian Institute Heath Grant (CIHR): Reference Number/W11-179912 and Women's Health Research Institute (WHRI), Vancouver, BC, Canada. M.A.B: Research grants from Canadian Institute for Health Research (CIHR) and Ferring Pharmaceutical. M.A.B. is on the advisory board for AbbVie and Baxter. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Mohamed A Bedaiwy
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Bahi Fayek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Emily C Yang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Mahmoud S Iews
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohamed Elgendi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Amr O Abdelkareem
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed H Abdellah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Yang Doris Liu
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Adrian Jones
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Faten F Abdel Hafez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Yang H, Wang G, Liu C, Ding L, Li Y, Chen Y, Teng Y, Xu Z, Ye Z, Zhao Y, Mu L. Elevated serum uric acid level is associated with adverse reproductive outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycles: a retrospective cohort study. Am J Obstet Gynecol 2023; 228:324.e1-324.e10. [PMID: 36403859 DOI: 10.1016/j.ajog.2022.11.1287] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/31/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Serum uric acid levels are elevated in polycystic ovary syndrome, however, the relationship between serum uric acid level and reproductive outcomes in women with polycystic ovary syndrome remains unclear. OBJECTIVE This study aimed to investigate the association between serum uric acid level and the reproductive outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycles. STUDY DESIGN This was a retrospective cohort study performed at a university-affiliated reproductive medicine center. A total of 1903 women with polycystic ovary syndrome undergoing their first in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycles between January 2010 and January 2021 were initially included. The trends for reproductive outcomes in polycystic ovary syndrome across quartiles of serum uric acid levels were assessed. A logistic regression analysis was performed to obtain the odds ratios for in vitro fertilization outcomes based on the quartiles of serum uric acid with or without adjusting for potential confounding variables. Using generalized additive models, serum uric acid was further treated as its original continuous property to visualize its nonlinear relationship with in vitro fertilization outcomes. The live birth rate was the main outcome. RESULTS After exclusions, a total of 883 women with polycystic ovary syndrome with their first fresh-embryo transfer cycles were included. In quartiles of serum uric acid levels, there was a significant decreasing trend in the live birth rate from the lowest quartile (Q1: 61.8%) to the highest (Q4: 45.9%) (Ptrend=.002). The percentage of low birthweight increased from Q1 (22.3%) to Q4 (31.7%) (Ptrend=.049). Compared with those in Q1, women in Q4 showed a significant lower probability of live birth and clinical pregnancy and a higher risk for low birthweight (all P<.05). Both the unadjusted and adjusted generalized additive models indicated that as the serum uric acid level increased, the probability of clinical pregnancy and the live birth rate exhibited an overall decreasing profile, and the risk for low birthweight showed an increasing profile. CONCLUSION An elevated serum uric acid level is associated with decreased probabilities of live birth and clinical pregnancy and an increased risk for low birthweight in women with polycystic ovary syndrome. However, these associations may be confounded by other factors and more well-designed studies are needed to confirm these findings in the future.
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Affiliation(s)
- Haiyan Yang
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiquan Wang
- Center for Reproductive Medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Chang Liu
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lin Ding
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yan Li
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Chen
- The First School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yili Teng
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhihui Xu
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenhong Ye
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Yue Zhao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Liangshan Mu
- Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Zhang Y, Liu Y, Li Z, Guan Y. Comparison of reproductive outcomes in subclinical hypothyroidism women with high-normal versus low-normal thyroid-stimulating hormone levels after treatment with levothyroxine. Clin Endocrinol (Oxf) 2023; 98:426-435. [PMID: 35902367 DOI: 10.1111/cen.14802] [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] [Received: 03/27/2022] [Revised: 06/29/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Reproductive outcomes in euthyroid women with high-normal thyroid-stimulating hormone (TSH) levels are comparable to those in euthyroid women with low TSH levels; however, few studies have investigated whether strictly controlled TSH levels after levothyroxine (LT4) treatment impair reproductive outcomes in infertile women with subclinical hypothyroidism (SCH). This study aimed to investigate the impact of high-normal versus low-normal TSH levels on reproductive outcomes in women undergoing their first in vitro fertilisation and embryo transfer (IVF-ET) cycle. DESIGN This was a retrospective cohort study. Patients were divided into low-normal (TSH < 2.5 mIU/L, and ≥0.27 mIU/L) and high-normal (TSH ≥ 2.5 mIU/L, and <4.2 mIU/L) groups based on TSH levels after LT4 treatment. TSH levels after LT4 treatment and before ovarian stimulation were recorded. Reproductive outcomes were compared between the low-normal and high-normal TSH groups and between the euthyroid and LT4-treated groups. RESULTS A total of 6002 women, 548 of whom were LT4-treated women, were finally included in this study. Among the LT4-treated women, 129 women had low-normal TSH levels, and 167 women had high-normal TSH levels. The clinical pregnancy rate, miscarriage rate, and live birth rate were comparable between the low-normal and high-normal groups (all p > .05). When adjusted by age, anti-Mullerian hormone (AMH) levels, infertility duration, transferred embryos, and dose and duration of LT4 treatment, high-normal TSH levels neither significantly decreased miscarriage (adjusted odds ratio [aOR] = 2.27, 95% confidence interval [CI] = 0.77-6.69, p = .14) nor increased clinical pregnancy (aOR = 1.15, 95% CI = 0.70-1.89, p = .57 or live birth (aOR = 0.97, 95% CI = 0.60-1.59, p = .92). Similar obstetric outcomes were observed between the low-normal and high-normal TSH groups after LT4 treatment and between the euthyroid and LT4-treated groups (all p ≥ .05). CONCLUSIONS High-normal TSH levels did not have adverse effects on clinical and obstetric outcomes when compared with low-normal TSH levels after LT4 treatment. However, whether it is appropriate to set 2.5 mIU/L as the goal of treatment before IVF/ICSI remains to be determined in further well-designed studies.
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Affiliation(s)
- Yuchao Zhang
- Department of Reproductive Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanli Liu
- Department of Reproductive Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen Li
- Department of Reproductive Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yichun Guan
- Department of Reproductive Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Shao M, Wang X, Zhou X. Case Report: Ovarian pregnancy, a rare but lethal condition: An analysis of 112 cases. Front Surg 2023; 10:1062228. [PMID: 36874462 PMCID: PMC9982079 DOI: 10.3389/fsurg.2023.1062228] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/11/2023] [Indexed: 02/19/2023] Open
Abstract
Study Objective To explore how to improve the treatment, and prognosis of ovarian pregnancy (OP). Patients A total of 111 OP patients, one of the patients suffered from OP twice. Results In this study, 112 OP cases confirmed by postoperative pathology were retrospectively analyzed. Common risk factors for OP were previous abdominal surgery (39.29%) and intrauterine device use (18.75%). We modified the ultrasonic classification into four types: gestational sac type, hematoma type I, hematoma type II, and intraperitoneal hemorrhage type. Among these four types, the proportion of patients who underwent emergency surgery as initial treatment after admission was 68.75%, 10.00%, 92.00%, and 81.36%, respectively. The treatment for hematoma type I patients was often delayed. The rate of OP rupture was 86.61%. All methotrexate therapy for OP patients failed. All these 112 cases underwent surgery treatment finally. The surgical procedures were pregnancy ectomy and ovarian reconstruction by laparoscopy or laparotomy. No significant differences were observed in the operation time or intraoperative blood loss between laparoscopy and laparotomy. Laparoscopy showed less influence on patients regarding length of hospital stay and postoperative fever than laparotomy. Further, 49 patients who desired fertility were followed up over 3 years. Among them, 24 (48.98%) experienced spontaneous intrauterine pregnancy. Conclusion Among the four modified ultrasonic classifications, hematoma type I was associated with more delays in surgical time. Laparoscopic surgery was a better choice for OP treatment. The reproductive prognosis of OP patients was promising.
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Affiliation(s)
- Mengyuan Shao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xinyi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Zhou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Adler A, Roth B, Lundy SD, Takeshima T, Yumura Y, Kuroda S. Sperm DNA fragmentation testing in clinical management of reproductive medicine. Reprod Med Biol 2023; 22:e12547. [PMID: 37915974 PMCID: PMC10616814 DOI: 10.1002/rmb2.12547] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/26/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
Background Approximately 8%-12% of couples worldwide face infertility, with infertility of individuals assigned male at birth (AMAB) contributing to at least 50% of cases. Conventional semen analysis commonly used to detect sperm abnormalities is insufficient, as 30% of AMAB patients experiencing infertility show normal results in this test. From a genetic perspective, the assessment of sperm DNA fragmentation (SDF) is important as a parameter of sperm quality. Methods In this narrative study, we review and discuss pathophysiological causes, DNA repair mechanisms, and management of high SDF. We then summarize literature exploring the association between SDF and reproductive outcomes. Main Findings Recent systematic reviews and meta-analyses have revealed a significant association between high SDF in AMAB individuals and adverse reproductive outcomes including embryo development, natural conception, intrauterine insemination, and in vitro fertilization. However, the association with live birth rates and pregnancy rates following intracytoplasmic injection remains inconclusive. The disparities among quantitative assays, inconsistent reference range values, absent high-quality prospective clinical trials, and clinical heterogeneity in AMAB patients with elevated SDF represent the main limitations affecting SDF testing. Conclusion The evaluation and management of SDF plays an important role in a subset of AMAB infertility, but widespread integration into clinical guidelines will require future high-quality clinical trials and assay standardization.
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Affiliation(s)
- Ava Adler
- Glickman Urological & Kidney InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Bradley Roth
- Glickman Urological & Kidney InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Scott D. Lundy
- Glickman Urological & Kidney InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Teppei Takeshima
- Department of Urology, Reproduction CenterYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Yumura
- Department of Urology, Reproduction CenterYokohama City University Medical CenterYokohamaJapan
| | - Shinnosuke Kuroda
- Glickman Urological & Kidney InstituteCleveland Clinic FoundationClevelandOhioUSA
- Department of Urology, Reproduction CenterYokohama City University Medical CenterYokohamaJapan
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Verberkt C, Lemmers M, de Leeuw RA, van Mello NM, Groenman FA, Hehenkamp WJ, Huirne JA. Effectiveness, complications, and reproductive outcomes after cesarean scar pregnancy management: a retrospective cohort study. AJOG Glob Rep 2022; 3:100143. [PMID: 36691399 PMCID: PMC9860491 DOI: 10.1016/j.xagr.2022.100143] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a dramatic rise in cesarean deliveries worldwide, leading to higher complication rates in subsequent pregnancies. One of these complications is a cesarean scar pregnancy. During the last decades, treatment options for cesarean scar pregnancies have changed, and less invasive interventions have been employed to preserve fertility and reduce morbidity. However, the optimal treatment approach and the influence of various treatments on reproductive outcomes have to be determined. OBJECTIVE This study aimed to evaluate the short- and long-term outcomes after cesarean scar pregnancy management. STUDY DESIGN We conducted a retrospective cohort study of women determined to have a cesarean scar pregnancy from 2010 to 2021 at a tertiary referral center, the Amsterdam University Medical Center, in the Netherlands. Outcomes of the following management strategies were compared: expectant management, methotrexate, curettage with temporary cervical cerclage, or a laparoscopic niche resection. We performed a curettage if the cesarean scar pregnancy did not cross the serosal line of the uterus, and a laparoscopic niche resection was performed if the cesarean scar pregnancy crossed the serosal line. The main outcomes were treatment efficacy and time to subsequent ongoing pregnancy or pregnancy leading to a live birth. RESULTS Of the 60 included women, 5 (8.3%) were managed expectantly, 8 (13.3%) were treated with methotrexate, 31 (51.8%) were treated with a curettage, and 16 (26.7%) with a laparoscopic niche resection. The groups were not comparable. The gestational age and human chorionic gonadotropin levels were generally higher in women who received methotrexate or a laparoscopic niche resection. Additional treatment in the conservative group was needed for 4 (80%) women after expectant management and for 7 (87.5%) women after methotrexate treatment. In the surgical group, all 31 women treated with a curettage and all 16 treated with a laparoscopic niche resection did not require additional treatment. The subsequent ongoing pregnancy rate after cesarean scar pregnancy management was 81.1% (30/37) among women who wished to conceive, with a live birth rate of 78.4% (29/37); 1 woman was in her third trimester of pregnancy at the time of analyses. The time between cesarean scar pregnancy management and subsequent ongoing pregnancy was 4 months (interquartile range, 3-6; P=.02) after expectant management, 18 months (interquartile range, 13-22) after initial methotrexate treatment, 5 months (interquartile range, 3-14; P=.01) after a curettage, and 6 months (interquartile range, 4-15; P=.03) after a laparoscopic niche resection. CONCLUSION Surgical treatment of a cesarean scar pregnancy led to a high success rate without additional interventions, high pregnancy rates with a short time interval between treatment, and subsequent pregnancy leading to an ongoing pregnancy or live birth. Conservative management, both with expectant management and methotrexate treatment, led to high (re)intervention rates. Different management approaches are indicated for different types of cesarean scar pregnancies.
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Affiliation(s)
- Carry Verberkt
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, VU Medical Center, Amsterdam, The Netherlands (Dr Verberkt)
| | - Marike Lemmers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands (Drs Lemmers, de Leeuw, van Mello, Groenman, Hehenkamp, and Huirne)
| | - Robert A. de Leeuw
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands (Drs Lemmers, de Leeuw, van Mello, Groenman, Hehenkamp, and Huirne)
| | - Norah M. van Mello
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands (Drs Lemmers, de Leeuw, van Mello, Groenman, Hehenkamp, and Huirne)
| | - Freek A. Groenman
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands (Drs Lemmers, de Leeuw, van Mello, Groenman, Hehenkamp, and Huirne)
| | - Wouter J.K. Hehenkamp
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands (Drs Lemmers, de Leeuw, van Mello, Groenman, Hehenkamp, and Huirne)
| | - Judith A.F. Huirne
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands (Drs Lemmers, de Leeuw, van Mello, Groenman, Hehenkamp, and Huirne)
- Corresponding author:
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Liu P, Li Z, Cheng X, Gao Q, Che Y, Zhang Z, Chu R, Chen Z, Zhang Y, Wang Q, Dou Z, Wei Y, Cui Z, Wang J, Xie X, Ma D, Yang X, Kong B, Song K. Assessment of prognostic and reproductive outcomes of omentectomy for patients with clinically apparent early-stage (I, II) malignant ovarian germ cell tumours: A multicentre retrospective study. BJOG 2022; 129 Suppl 2:23-31. [PMID: 36485067 DOI: 10.1111/1471-0528.17325] [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: 12/13/2022]
Abstract
OBJECTIVE This study assessed the effect of omentectomy on the prognosis and fertility in patients with clinically early-stage (I, II) malignant ovarian germ cell tumours (MOGCT). DESIGN A retrospective multicentre study. SETTING Four university teaching hospitals in China. POPULATION A total of 268 patients with clinically apparent early-stage (I, II) MOGCT. METHODS Data were obtained from the medical records. Additionally, the propensity score matching (PSM) algorithm was adopted. MAIN OUTCOME MEASURES Prognostic outcomes were disease-free survival (DFS) and overall survival (OS). Fertility outcomes were pregnancy and live birth rates. RESULTS A total of 187 (69.8%) patients underwent omentectomy. Kaplan-Meier analysis showed no significant differences in DFS and OS between the omentectomy and non-omentectomy groups before and after PSM (p > 0.05). Additionally, subgroup analysis stratified by age (<18 and ≥18 years) showed similar results. International Federation of Gynecology and Obstetrics (FIGO) stage was the only risk factor associated with DFS (hazard ratio [HR] 14.71, 95% confidence interval [CI] 4.47-48.38, p < 0.001) and OS (HR 37.36, 95% CI 3.87-361.16, p = 0.002). Pregnancy and live birth rates in the total population were 80.3% and 66.7%, respectively. There were no significant differences between the two groups before and after PSM. CONCLUSIONS Omentectomy did not improve survival or affect fertility in patients with clinically apparent early-stage (I, II) MOGCT, regardless of the age. The clinical FIGO stage was an independent risk factor for recurrence and death.
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Affiliation(s)
- Penglin Liu
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhuang Li
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaodong Cheng
- Department of Gynaecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qinglei Gao
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanci Che
- Department of Obstetrics and Gynaecology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaoyang Zhang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Ran Chu
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhongshao Chen
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yue Zhang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Qiannan Wang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiyuan Dou
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuan Wei
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhumei Cui
- Department of Obstetrics and Gynaecology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianliu Wang
- Department of Obstetrics and Gynaecology, Peking University People's Hospital, Beijing, China
| | - Xing Xie
- Department of Gynaecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ding Ma
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingsheng Yang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Beihua Kong
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China.,Key Laboratory of Gynaecological Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Kun Song
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China.,Key Laboratory of Gynaecological Oncology, Qilu Hospital of Shandong University, Jinan, China
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Lynch MT, Maloney KA, Pollin TI, Streeten EA, Puffenberger EG, Strauss KA, Shuldiner AR, Mitchell BD. Impact of parental relatedness on reproductive outcomes among the Old Order Amish of Lancaster County. Am J Med Genet A 2022; 188:2119-2128. [PMID: 35442562 DOI: 10.1002/ajmg.a.62757] [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: 10/26/2021] [Revised: 02/01/2022] [Accepted: 03/18/2022] [Indexed: 11/06/2022]
Abstract
Genetically isolated populations that arise due to recent bottleneck events have reduced genetic variation reflecting the common set of founders. Increased genetic relatedness among members of isolated populations puts them at increased risk for some recessive disorders that are rare in outbred populations. To assess the burden on reproductive health, we compared frequencies of adverse reproductive outcomes between Amish couples who were both heterozygous carriers of a highly penetrant pathogenic or likely pathogenic variant and noncarrier couples from the same Amish community. In addition, we evaluated whether overall genetic relatedness of parents was associated with reproductive outcomes. Of the 1824 couples included in our study, 11.1% were at risk of producing a child with an autosomal recessive disorder. Carrier couples reported a lower number of miscarriages compared to noncarrier couples (p = 0.02), although the number of stillbirths (p = 0.3), live births (p = 0.9), and number of pregnancies (p = 0.9) did not differ significantly between groups. In contrast, higher overall relatedness between spouses was positively correlated with number of live births (p < 0.0001), pregnancies (p < 0.0001), and stillbirths (p = 0.03), although not with the number of miscarriages (p = 0.4). These results highlight a complex association between relatedness of parents and reproductive health outcomes in this community.
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Affiliation(s)
- Megan T Lynch
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Medicine Baltimore, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kristin A Maloney
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Medicine Baltimore, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Toni I Pollin
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Medicine Baltimore, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth A Streeten
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Medicine Baltimore, University of Maryland School of Medicine, Baltimore, Maryland, USA
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- Regeneron Genetics Center LLC, Tarrytown, New York, USA
| | | | - Braxton D Mitchell
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Medicine Baltimore, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, Maryland, USA
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Vitale SG, Riemma G, Carugno J, Perez-Medina T, Alonso Pacheco L, Haimovich S, Parry JP, Di Spiezio Sardo A, De Franciscis P. Postsurgical barrier strategies to avoid the recurrence of intrauterine adhesion formation after hysteroscopic adhesiolysis: a network meta-analysis of randomized controlled trials. Am J Obstet Gynecol 2022; 226:487-498.e8. [PMID: 34555319 DOI: 10.1016/j.ajog.2021.09.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To assess the efficacy of mechanical strategies to avoid the recurrence of intrauterine adhesions, to evaluate the impact on subsequent fertility after hysteroscopic adhesiolysis and to rank the available antiadhesive options. DATA SOURCES MEDLINE, Scopus, ClinicalTrials.gov, CINAHL, Scielo, EMBASE, PROSPERO, Cochrane Library, conference proceedings, and international controlled trials registries were searched without temporal, geographic, and language restrictions. STUDY ELIGIBILITY CRITERIA Randomized trials that analyzed the recurrence, reproductive outcomes, or both in women undergoing hysteroscopic adhesiolysis followed by mechanical prevention of intrauterine adhesions were included. The exclusion criteria included the following: quasi-randomized trials and trials without randomization and studies including patients undergoing hysteroscopic surgery that was different from adhesiolysis. STUDY APPRAISAL AND SYNTHESIS METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension statement for network meta-analyses guidelines were followed. We performed a network meta-analysis based on the random effects model for mixed multiple treatment comparisons to rank the antiadhesive strategies by surface under the cumulative ranking curve area. Quality assessment was performed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was the recurrent presence of intrauterine adhesions. RESULTS Eleven studies with data for 1596 women were identified as applicable. A copper intrauterine device together with an intrauterine balloon (surface under the cumulative ranking curve area=46.4%) or with cross-linked hyaluronic acid gel (surface under the cumulative ranking curve area=21.3%) seemed effective in preventing adhesions recurrence. Regarding the fecundity, hyaluronic acid gel demonstrated the highest pregnancy rates (surface under the cumulative ranking curve area=79.8%). The greatest degrees of change in the mean adhesions scores were found with the use of hyaluronic acid gel plus an intrauterine device (surface under the cumulative ranking curve area=38.9%). For postsurgical adhesion severity, hyaluronic acid gel plus intrauterine device (surface under the cumulative ranking curve area=49.9%) followed by intrauterine device alone (surface under the cumulative ranking curve area=30.8%) was ranked the highest. Dried amnion graft (surface under the cumulative ranking curve area=53.8%) and uterine balloon (surface under the cumulative ranking curve area=45%) showed the greatest menstrual pattern improvement. CONCLUSION Cross-linked hyaluronic acid gel, with or without insertion of a copper intrauterine device, seems to be the most effective approach. However, the lack of a clear best therapy suggests the need for further studies to draw firm conclusions.
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Sık BA, Ozdamar O, Ozolcay O, Sismanoglu A, Aba YA, Oral S, Koc M. Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI. J OBSTET GYNAECOL 2022; 42:2265-2271. [PMID: 35275047 DOI: 10.1080/01443615.2022.2038105] [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: 10/18/2022]
Abstract
The aim of this study was to compare the reproductive outcomes between infertile women who underwent hysteroscopic uterine septum resection and those who required a second look hysteroscopy due to residual septum prior to intracytoplasmic sperm injection (ICSI) cycles with selective single 'Grade A' embryo transfer (ET). All second look hysteroscopies were performed due to partial remnant septum in a control three dimensional transvaginal ultrasonography (3D TVUSG) after the first hysteroscopic resection. Miscarriage and biochemical pregnancy rates were not different between the groups while clinical pregnancy and live birth rates were significantly higher in Group 2 than in Group 1. Second look hysteroscopic metroplasty performed to restore remnant septum significantly improves live birth rate as well as clinical pregnancy rates while it appears not to alleviate abortion and biochemical pregnancy rates in women undergoing ICSI-ET.IMPACT STATEMENTWhat is already known on this subject? The effect of hysteroscopic septum resection on reproductive outcomes in IVF treatment in infertile patients with uterine septum is not clearly known.What do the results of this study add? With the selective single ET strategy, complete or partial hysteroscopic correction of the uterine septum before ICSI and subsequent resection of the residual septum with control hysteroscopy significantly increases the live birth rates in the infertile population.What are the implications of these findings for clinical practice and/or further research? In the group of infertile patients with uterine septum, second control hysteroscopy should be performed 1 month later for residual septum or adhesions after hysteroscopic septum resection performed once.
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Affiliation(s)
- Bulat Aytek Sık
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Ozkan Ozdamar
- Department of Reproductive Endocrinology and Infertility, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Ozan Ozolcay
- Department of Reproductive Endocrinology and Infertility, Istanbul IVF Centre, Istanbul, Turkey
| | - Alper Sismanoglu
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Yilda Arzu Aba
- Health Sciences Faculty, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Serkan Oral
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Mehmet Koc
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
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Corbett GA, Lee S, Woodruff TJ, Hanson M, Hod M, Charlesworth AM, Giudice L, Conry J, McAuliffe FM. Nutritional interventions to ameliorate the effect of endocrine disruptors on human reproductive health: A semi-structured review from FIGO. Int J Gynaecol Obstet 2022; 157:489-501. [PMID: 35122246 PMCID: PMC9305939 DOI: 10.1002/ijgo.14126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/28/2021] [Accepted: 02/02/2022] [Indexed: 11/09/2022]
Abstract
Background Endocrine disrupting chemicals have harmful effects on reproductive, perinatal, and obstetric outcomes. Objective To analyze the evidence on nutritional interventions to reduce the negative effects of endocrine disruptors on reproductive, perinatal, and obstetric outcomes. Search strategy A search of MEDLINE (PubMed), Allied Health Literature (CINAHL), EMBASE, Web of Science, and the Cochrane Database was conducted from inception to May 2021. Selection criteria Experimental studies on human populations. Data collection and analysis Data were collected from eligible studies. Risk of bias assessment was completed using the Cochrane risk of bias tool and the ROBINS‐I Tool. Results Database searches yielded 15 362 articles. Removing 11 181 duplicates, 4181 articles underwent abstract screening, 26 articles were eligible for full manuscript review, and 16 met full inclusion criteria. Several interventions were found to be effective in reducing exposure to endocrine disruptors: avoidance of plastic containers, bottles, and packaging; avoidance of canned food/beverages; consumption of fresh and organic food; avoidance of fast/processed foods; and supplementation with vitamin C, iodine, and folic acid. There were some interventional studies examining therapies to improve clinical outcomes related to endocrine disruptors. Conclusion Dietary alterations can reduce exposure to endocrine disruptors, with limited data on interventions to improve endocrine‐disruptor–related clinical outcomes. This review provides useful instruction to women, their families, healthcare providers, and regulatory bodies. Nutritional interventions shown to reduce exposure to endocrine disruptors include avoidance of canned/processed or plastic‐packaged foods. Consumption of fresh/organic foods and vitamin C, iodine, and folic acid also reduce exposure.
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Affiliation(s)
- Gillian A Corbett
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sadhbh Lee
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Tracey J Woodruff
- Program on Reproductive Health and Environment, Department of Obstetrics and Gynecology, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Mark Hanson
- International Federation of Gynaecology and Obstetrics (FIGO) Committee on Impact of Pregnancy on Long-term Health.,Institute of Developmental Sciences and NIHR Biomedical Research Centre, University of Southampton and NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Moshe Hod
- International Federation of Gynaecology and Obstetrics (FIGO) Committee on Impact of Pregnancy on Long-term Health.,Mor Comprehensive Women's Health Care Centre, Tel Aviv, Israel
| | - Anne Marie Charlesworth
- Program on Reproductive Health and Environment, Department of Obstetrics and Gynecology, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Linda Giudice
- International Federation of Gynecology and Obstetrics (FIGO) Committee on Climate Change and Toxic Environmental Exposures.,Centre for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Jeanne Conry
- Environmental Health and Leadership Foundation, United States
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,International Federation of Gynaecology and Obstetrics (FIGO) Committee on Impact of Pregnancy on Long-term Health
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Li L, Sun B, Wang F, Zhang Y, Sun Y. Which Factors Are Associated With Reproductive Outcomes of DOR Patients in ART Cycles: An Eight-Year Retrospective Study. Front Endocrinol (Lausanne) 2022; 13:796199. [PMID: 35813637 PMCID: PMC9259947 DOI: 10.3389/fendo.2022.796199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Women with diminished ovarian reserve (DOR) have a lower pregnancy rate and higher cancellation rate compared to those without DOR when seeking assisted reproductive technology. However, which factors are associated with reproductive outcomes and whether AMH is a predictor of clinical pregnancy remain unclear. OBJECTIVE This retrospective study was designed to find factors associated with reproductive outcomes in DOR patients and then discuss the role of AMH in predicting cycle results among this population. METHOD A total of 900 women were included in the study. They were diagnosed with DOR with the following criteria: (i) FSH > 10 IU/L; (ii)AMH < 1.1 ng/ml; and (iii) AFC <7. They were divided into different groups: firstly, based on whether they were clinically pregnant or not, pregnant group vs. non-pregnant group (comparison 1); secondly, if patients had transferrable embryos (TE) or not, TE vs. no TE group (comparison 2); thirdly, patients undergoing embryo transfer (ET) cycles were divided into pregnant I and non-pregnant I group (comparison 3). The baseline and ovarian stimulation characteristics of these women in their first IVF/ICSI cycles were analyzed. Logistic regression was performed to find factors associated with clinical pregnancy. RESULTS Of the 900 DOR patients, 138 women got pregnant in their first IVF/ICSI cycles while the rest did not. AMH was an independent predictor of TE after adjusting for confounding factors (adjusted OR:11.848, 95% CI: 6.21-22.62, P< 0.001). Further ROC (receiver operating characteristic) analysis was performed and the corresponding AUC (the area under the curve) was 0.679 (95% CI: 0.639-0.72, P< 0.001). Notably, an AMH level of 0.355 had a sensitivity of 62.6% and specificity of 65.6%. However, there was no statistical difference in AMH level in comparison 3, and multivariate logistic regression showed female age was associated with clinical pregnancy in ET cycles and women who were under 35 years old were more likely to be pregnant compared to those older than 40 years old (adjusted OR:4.755, 95% CI: 2.81-8.04, P< 0.001). CONCLUSION AMH is highly related to oocyte collection rate and TE rate,and 0.355 ng/ml was a cutoff value for the prediction of TE. For DOR patients who had an embryo transferred, AMH is not associated with clinical pregnancy while female age is an independent risk factor for it.
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Affiliation(s)
- Lu Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Wang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yile Zhang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yingpu Sun,
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Allen NG, Edupuganti L, Edwards DJ, Jimenez NR, Buck GA, Jefferson KK, Strauss JF, Wickham EP, Fettweis JM. The vaginal microbiome in women of reproductive age with healthy weight versus overweight/obesity. Obesity (Silver Spring) 2022; 30:142-152. [PMID: 34806323 PMCID: PMC9070090 DOI: 10.1002/oby.23306] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the differences between the vaginal microbiome of reproductive-aged women with overweight and obesity (Ow/Ob) compared with healthy weight (HW). METHODS In this case-control study, a cohort of 367 nonpregnant women (18 to 40 years) with Ow/Ob (BMI ≥25 kg/m2 ) was case-matched with 367 women with HW (BMI 18.0 to 24.9 kg/m2 ). The study was a secondary analysis of 16S rRNA vaginal microbiome surveys through the Vaginal Human Microbiome Study (VaHMP). Groups were matched on age, race/ethnicity, income, and nulliparity status. RESULTS Mean age and BMI of Ow/Ob and HW groups were 26.8 versus 26.7 years and 37.0 versus 22.1 kg/m2 , respectively. The overall vaginal microbiome composition differed between groups (PERMANOVA, p = 0.035). Women with Ow/Ob had higher alpha diversity compared with women with HW (Wilcoxon test, Shannon index p = 0.025; inverse Simpson index p = 0.026). Lactobacillus dominance (≥30% proportional abundance) was observed in a greater proportion of women with HW (48.7%) compared with Ow/Ob (40.1%; p = 0.026). CONCLUSIONS The vaginal microbiome differs in reproductive-aged women with Ow/Ob compared with women with HW, with increased alpha diversity and decreased predominance of Lactobacillus. Observed differences in the vaginal microbiome may partially explain differences in preterm birth and bacterial vaginosis risk between these populations.
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Affiliation(s)
- Natalie G. Allen
- Department of Pediatrics, Division of Endocrinology and Diabetes, Penn State Health, Hershey, Pennsylvania, USA
- Department of Pediatrics, Division of Endocrinology, Diabetes, and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Laahirie Edupuganti
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - David J. Edwards
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole R. Jimenez
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gregory A. Buck
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kimberly K. Jefferson
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jerome F. Strauss
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Edmond P. Wickham
- Department of Pediatrics, Division of Endocrinology, Diabetes, and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer M. Fettweis
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
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Qin DY, Jiang HH, Yao QY, Yao W, Yuan XQ, Wang Y, Deng TR, Du YY, Ren XL, Guo N, Li YF. Rescue in vitro maturation may increase the pregnancy outcomes among women undergoing intracytoplasmic sperm injection. Front Endocrinol (Lausanne) 2022; 13:1047571. [PMID: 36578963 PMCID: PMC9790966 DOI: 10.3389/fendo.2022.1047571] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION To investigate whether rescue in vitro maturation (R-IVM) improves the reproductive outcomes among women undergoing intracytoplasmic sperm injection (ICSI) after one oocyte retrieved cycle. METHODS Between January 2019 and December 2020, 2602 women who underwent ICSI in the Reproductive Medicine Center of Tongji Hospital, Wuhan, China, were included in our retrospective cohort study. There were 2112 women undergoing only ICSI and 490 women with R-IVM followed by ICSI. The intermediate reproductive outcomes and pregnancy outcomes were assessed, including the number of normally fertilized embryos, number of cleaved embryos, number of good-quality embryos, number of day-3 available embryos, number of embryos cultured past day-3, number of blastocysts, number of available blastocysts, biochemical pregnancy, miscarriage, clinical pregnancy and live birth. The perinatal outcomes were also assessed, including preterm birth and birth weight. The abovementioned outcomes were also calculated for in vivo matured and R-IVM oocytes separately in women undergoing ICSI with R-IVM group. RESULTS Compared with the women who underwent only ICSI, those who underwent ICSI with R-IVM had higher numbers of MII oocytes, normally fertilized embryos, cleaved embryos, day-3 available embryos, embryos cultured past day-3, and higher oocyte maturation rate, available embryo rate than women undergoing only ICSI. Additionally, we found that women undergoing ICSI with R-IVM had an increased chance of clinical pregnancy (adjusted OR=1.50, 95% CI: 1.17-1.93) and cumulative live birth (adjusted OR=1.35, 95% CI: 1.07-1.71). After propensity score matching (PSM), the cumulative live birth rate was 60.1% for women undergoing ICSI with R-IVM versus 54.9% for women undergoing only ICSI (OR=1.24, 95% CI: 0.94-1.63). The reproductive outcomes were also significantly different when calculated for in vivo matured and R-IVM oocytes separately in women undergoing ICSI with R-IVM group. All live births from R-IVM embryos were healthy and without malformations or complications. CONCLUSION R-IVM may improve the reproductive outcomes of women undergoing ICSI. It may also provide a reference for the safety of R-IVM. This study maybe support a routine application of R-IVM among patients who intend to undergo ICSI.
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Affiliation(s)
- Dan-Yu Qin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Hua Jiang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Qing-Yun Yao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Yao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Qiong Yuan
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao-Ran Deng
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao-Yao Du
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin-Ling Ren
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Na Guo
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Na Guo, ; Yu-Feng Li,
| | - Yu-Feng Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Na Guo, ; Yu-Feng Li,
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Toson B, Simon C, Moreno I. The Endometrial Microbiome and Its Impact on Human Conception. Int J Mol Sci 2022; 23:ijms23010485. [PMID: 35008911 PMCID: PMC8745284 DOI: 10.3390/ijms23010485] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 12/18/2022] Open
Abstract
Changes in the female genital tract microbiome are consistently correlated to gynecological and obstetrical pathologies, and tract dysbiosis can impact reproductive outcomes during fertility treatment. Nonetheless, a consensus regarding the physiological microbiome core inside the uterine cavity has not been reached due to a myriad of study limitations, such as sample size and experimental design variations, and the influence of endometrial bacterial communities on human reproduction remains debated. Understanding the healthy endometrial microbiota and how changes in its composition affect fertility would potentially allow personalized treatment through microbiome management during assisted reproductive therapies, ultimately leading to improvement of clinical outcomes. Here, we review current knowledge regarding the uterine microbiota and how it relates to human conception.
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Affiliation(s)
- Bruno Toson
- INCLIVA Biomedical Research Institute, Av. Menendez y Pelayo 4, 46010 Valencia, Spain;
| | - Carlos Simon
- Igenomix Foundation/INCLIVA Biomedical Research Institute, Narcis Monturiol Estarriol 11B, 46980 Paterna, Spain
- Department of Obstetrics and Gynecology, University of Valencia, Av. Blásco Ibáñez 15, 46010 Valencia, Spain
- Beth Israel Deaconess Medical Center, Harvard University, 330 Brookline Ave, Boston, MA 02215, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
- Correspondence: (C.S.); (I.M.)
| | - Inmaculada Moreno
- Igenomix Foundation/INCLIVA Biomedical Research Institute, Narcis Monturiol Estarriol 11B, 46980 Paterna, Spain
- Correspondence: (C.S.); (I.M.)
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Bortolus R, Filippini F, Cipriani S, Trevisanuto D, Cavallin F, Zanconato G, Somigliana E, Cesari E, Mastroiacovo P, Parazzini F. Efficacy of 4.0 mg versus 0.4 mg Folic Acid Supplementation on the Reproductive Outcomes: A Randomized Controlled Trial. Nutrients 2021; 13:nu13124422. [PMID: 34959975 PMCID: PMC8704306 DOI: 10.3390/nu13124422] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 01/13/2023] Open
Abstract
Folic acid (FA) supplementation prevents neural tube defects (NTDs), but the effects on other reproductive outcomes are unclear. While common recommendation is 0.4 mg/day in addition to regular nutrition, the most appropriate dose of FA is still under debate. We investigated the effects of a higher dose of periconception FA on reducing adverse reproductive outcomes. In this multicenter double-blind randomized controlled trial (RCT), 1060 women (aged 18-44 years and planning a pregnancy) were randomly assigned to receive 4.0 mg or 0.4 mg of FA daily. The primary outcome was the occurrence of congenital malformations (CMs). A composite outcome including one or more adverse pregnancy outcomes was also evaluated. A total of 431 women had a natural conception within 1 year. The primary outcome occurred in 8/227 (3.5%) women receiving 4.0 mg FA and 9/204 (4.4%) women receiving 0.4 mg FA (RR 0.80; 95%CI 0.31 to 2.03). The composite outcome occurred in 43/227 (18.9%) women receiving 4.0 mg FA and 75/204 (36.8%) women receiving 0.4 mg FA (RR 0.51; 95%CI 0.40 to 0.68). FA 4.0 mg supplementation was not associated with different occurrence of CMs, compared to FA 0.4 mg supplementation. However, FA 4.0 mg supplementation was associated with lower occurrence of other adverse pregnancy outcomes.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Verona University Hospital, 37134 Verona, Italy; (R.B.); (F.F.)
| | - Francesca Filippini
- Office for Research Promotion, Verona University Hospital, 37134 Verona, Italy; (R.B.); (F.F.)
| | - Sonia Cipriani
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.C.); (E.S.)
| | - Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University of Padua, 35128 Padova, Italy;
| | | | - Giovanni Zanconato
- Department of Surgery, Odontostomatology and Maternal and Child Health, University of Verona, 37134 Verona, Italy;
| | - Edgardo Somigliana
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.C.); (E.S.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Elena Cesari
- Department of Obstetrics and Gynaecology, Sant’Antonio Abate Hospital, 21013 Gallarate, Italy;
| | | | - Fabio Parazzini
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.C.); (E.S.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Correspondence:
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Lackamp N, Wilkemeyer I, Jelas I, Keller U, Bullinger L, Stintzing S, le Coutre P. Survey of Long-Term Experiences of Sperm Cryopreservation in Oncological and Non-Oncological Patients: Usage and Reproductive Outcomes of a Large Monocentric Cohort. Front Oncol 2021; 11:772809. [PMID: 34804976 PMCID: PMC8602360 DOI: 10.3389/fonc.2021.772809] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
Progress in oncological treatment has led to an improved long-term survival of young male cancer patients over the last decades. However, standard cancer treatments frequently implicate fertility-damaging potential. Cryopreservation of sperm is the current standard option to preserve patient’s fertility after treatment, yet long-term data on usage and reproductive experiences is still limited. Natural fertility after treatment and especially in relation to the type of treatment has been poorly analyzed so far. Therefore, we performed a retrospective survey including male patients with an indication for gonadotoxic treatment who cryopreserved reproductive material at our institution between 1994 and 2017. Study questionnaires regarding treatment, material usage, and reproductive outcomes were sent to eligible patients. Additionally, semen analyses of study participants from the time of cryopreservation were evaluated. A total of 99 patients were included in the study. Respondents’ median age was 38.0 years. Most frequent diagnoses were testicular cancer (29.3%) and lymphoma (26.3%). A further 8.1% suffered from autoimmune diseases. Testicular cancer patients had a significantly lower pre-treatment median sperm concentration (18.0 million/ml) compared to non-testicular cancer patients (54.2 million/ml). Until November 2020, the determined sperm usage and cumulative live-birth rate per couple were 17.2% and 58.8%, respectively. Most sperm users received treatments with high (40.0%) or intermediate (33.3%) gonadotoxic potential. 20.7% of all patients reported to had fathered at least one naturally conceived child after treatment, this being the case especially if they had been treated with less or potentially gonadotoxic therapies. In conclusion, our findings emphasize the importance of sperm cryopreservation in the context of male fertility preservation. Furthermore, they indicate that the gonadotoxic potential of patients’ treatments could represent a predictive factor for sperm usage.
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Affiliation(s)
- Nadine Lackamp
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ina Wilkemeyer
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ivan Jelas
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Stintzing
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp le Coutre
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Ban Frangež H, Vrtacnik Bokal E, Štimpfel M, Divjak Budihna T, Gulino FA, Garzon S, Ghezzi F, Alkatout I, Gitas G, Laganà AS. Reproductive outcomes after laparoscopic surgery in infertile women affected by ovarian endometriomas, with or without in vitro fertilisation: results from the SAFE (surgery and ART for endometriomas) trial. J OBSTET GYNAECOL 2021; 42:1293-1300. [PMID: 34585638 DOI: 10.1080/01443615.2021.1959536] [Citation(s) in RCA: 10] [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] [Indexed: 12/25/2022]
Abstract
We performed a retrospective cohort study, namely "Surgery and ART for Endometriomas" (SAFE) trial (Clinical Trial ID: NCT03717870), including women who underwent laparoscopic cystectomy for endometrioma before first IVF and compared their reproductive outcomes with the ones of women without endometriosis and with unexplained infertility, tubal factor or male factor infertility. We found that women who underwent previous laparoscopic cystectomy for endometrioma had higher FSH and LH levels between the 2nd and 5th day of the cycle before IVF, required higher doses of gonadotrophins for ovarian stimulation and had a lower number of retrieved oocytes compared with other types of infertility. Nevertheless, pregnancy and delivery rates remain comparable to other causes of infertility. In addition, differences in ovarian stimulation parameters between endometriosis and other types of infertility lost significance with the increase of women's age. These pieces of information can be considered useful to make adequate counselling about reproductive outcomes for infertile women with ovarian endometriomas and allow a proper decision-making approach shared with the patient.IMPACT STATEMENTWhat is already known on this subject? Although endometriomas are common findings in infertile women, whether they should be surgically removed before an in vitro fertilisation (IVF) is a long-lasting debate, and current evidence does not offer a robust background to draw firm recommendations.What do the results of this study add? Women who underwent previous laparoscopic cystectomy for endometrioma need higher doses of gonadotrophins for ovarian stimulation and have a lower number of retrieved oocytes, compared with other types of infertility. Pregnancy and delivery rates remain comparable to other causes of infertility.What are the implications of these findings for clinical practice and/or further research? These pieces of information can help to make adequate counselling about reproductive outcomes for infertile women with ovarian endometriomas and allow a proper decision-making approach shared with the patient.
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Affiliation(s)
- Helena Ban Frangež
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eda Vrtacnik Bokal
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Martin Štimpfel
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Teja Divjak Budihna
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, Kiel School of Gynecological Endoscopy, University Hospital Schleswig Holstein, Kiel, Germany
| | - Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Luebeck, Germany
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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