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Chen C, Shi H, Yang J, Bao X, Sun Y. The risk of breast cancer and gynecologic malignancies after ovarian stimulation: Meta-analysis of cohort study. Crit Rev Oncol Hematol 2024; 197:104320. [PMID: 38479585 DOI: 10.1016/j.critrevonc.2024.104320] [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: 10/17/2023] [Revised: 01/31/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
The effects of ovarian stimulation on breast and gynecological tumor incidence remain controversial. Therefore, the aim of this meta-analysis was to study the risk of cancer in ovarian stimulation. Of the 22713 studies initially identified, 28 were eligible for inclusion. The results revealed that the impact of ovarian cancer (RR = 1.33, [1.05; 1.69]) and cervical cancer (RR = 0.67, [0.46; 0.97]) is significant among the overall effects. In subgroup analysis, in the nulliparous population (RR = 0.81 [0.68; 0.96]) was the protective factor for the breast cancer. In the Caucasians subgroup (RR = 1.45, [1.12; 1.88]), the ovarian cancer incidence was statistically significant. In the Asian subgroup (RR = 1.51, [1.00; 2.28]), the endometrial cancer incidence was statistically significant. In the subgroup of Asians (RR = 0.55 [0.44; 0.68]) and the multiparous population (RR = 0.31, [0.21; 0.46]), them can be the statistically protective factor for the cervical cancer.
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Affiliation(s)
- Chuanju Chen
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hao Shi
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jingya Yang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiao Bao
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Shen Q, Wang B, He T, Li S, Peng EN, Lei J. Factors associated with discontinuation in fertility treatment: a systematic scoping review. J Assist Reprod Genet 2024; 41:409-421. [PMID: 37987953 PMCID: PMC10894784 DOI: 10.1007/s10815-023-02982-x] [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: 07/26/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE The discontinuation of fertility treatment could decrease the chances of achieving parenthood for infertile patients and often leads to economic loss and medical resource waste. However, the evidence on the factors associated with discontinuation is unclear and inconsistent in the context of fertility treatment. This scoping review aimed to summarize the evidence on factors associated with discontinuation in fertility treatment, identify the current knowledge gap, and generate recommendations for future research. METHODS We searched PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, American Psychological Association, and http://clinicaltrials.gov from inception to June 2023 without language or time restrictions. We also searched the grey literature in Open Grey and Google Scholar and hand-searched the reference lists of relevant studies to identify potentially eligible studies. Publications that studied factors associated with discontinuation in fertility treatment were included. The identified factors were mapped to the World Health Organization's treatment adherence model. RESULTS Thirty-seven articles involving 41,973 infertile patients from 13 countries were included in this scoping review. All studies identified the factors from the perspective of patients, except for one that described the factors from the healthcare providers' perspective. A total of 42 factors were identified, with most of them belonging to the patient-related dimension, followed by socio-economic-related, treatment-related, condition-related, and healthcare system-related dimensions. Female education level, social support, and insurance coverage decreased the likelihood of treatment discontinuation, whereas multiparous women, male infertility, depression, higher infertility duration, and treatment duration increased the likelihood of treatment discontinuation. Age, education level, and ethnicity are the commonly nonmodifiable factors for treatment discontinuation, while insurance coverage, depression, and anxiety symptoms are among some of the more commonly reported modifiable factors. CONCLUSION This is the first scoping review examining and synthesizing evidence on the factors influencing of discontinuation in fertility treatment. This review could inform researchers, clinicians, and policymakers to address modifiable barriers and facilitators to develop personalized and multicomponent interventions that could improve the discontinuation in fertility treatment.
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Affiliation(s)
- Quan Shen
- Department of Gynecology and Obstetrics of The Third XiangYa Hospital of Central South University, No138, Tongzipo Road, Changsha, 410013, Hunan Province, China
- Department of Reproductive Center of The Third XiangYa Hospital of Central South University, Changsha, Hunan Province, China
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Binglu Wang
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Tan He
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Suya Li
- Tongji Hospital of HuaZhong University of Science and Technology, Wuhan, Hubei Province, China
| | - ENuo Peng
- Department of Reproductive Center of The Third XiangYa Hospital of Central South University, Changsha, Hunan Province, China
| | - Jun Lei
- Department of Gynecology and Obstetrics of The Third XiangYa Hospital of Central South University, No138, Tongzipo Road, Changsha, 410013, Hunan Province, China.
- Department of Reproductive Center of The Third XiangYa Hospital of Central South University, Changsha, Hunan Province, China.
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Buhling KJ, Scheuer M, Laakmann E. Recommendation and intake of dietary supplements periconceptional and during pregnancy: results of a nationwide survey of gynaecologists. Arch Gynecol Obstet 2023; 308:1863-1869. [PMID: 37715805 PMCID: PMC10579106 DOI: 10.1007/s00404-023-07167-6] [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: 05/24/2023] [Accepted: 07/19/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Micronutrient supplementation during pregnancy is a controversial issue. For some micronutrients, for example folic acid or iodine, the evidence regarding supplementation is clear, whereas for others, such as zinc or vitamin E, it is not. Studies show that a large number of pregnant women have deficient levels of folic acid and iodine. However, especially with folic acid, starting supplementation during the preconception period is crucial. It is, therefore, important that gynaecologists explain this to their pregnant or preconceptional patients. Our goal was to find out how gynaecologists make their recommendations on this topic, how they assess the compliance of their patients and which micronutrients they consider to be important before/during pregnancy and during breastfeeding. METHOD AND RESULTS: We sent about 12,000 questionnaires to all registered resident gynaecologists in Germany, with a response rate of 12.2%. Regarding which micronutrients gynaecologists consider to be particularly important during pregnancy, there was a broad agreement for both folic acid and iodine (> 88% answered yes). According to the questionnaire, doctors rate other micronutrients, such as vitamin D and omega-3 fatty acids, as less essential. The controversial evidence level for many micronutrients certainly plays a role here. Overall, the intake rate, especially for preconceptional women, is classified as rather low (< 60%). The most widely valued reason is the high price of dietary supplements. It was also noticeable that doctors consider certain micronutrients to be particularly important but then do not include them in the products they recommend. CONCLUSION Overall, there seems to be uncertainty about micronutrients in pregnancy and their supplementation. The study situation is often ambiguous and there are no official guidelines, leading to ambiguous recommendations from doctors and therefore low intake rates for pregnant or preconceptional women.
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Affiliation(s)
- Kai J Buhling
- Department of Gynecological Endocrinology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Marie Scheuer
- Department of Gynecological Endocrinology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Elena Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Cusatis R, Johnson C, Schoyer KD, Tsaih SW, Balza J, Sandlow J, Flynn KE. Decision regret among couples experiencing infertility: a mixed methods longitudinal cohort study. Reprod Health 2023; 20:165. [PMID: 37940984 PMCID: PMC10633954 DOI: 10.1186/s12978-023-01699-5] [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: 06/01/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Decisions for how to resolve infertility are complex and may lead to regret. We examined whether couples and individuals who sought a consultation from a reproductive specialist for infertility later expressed decisional regret about their family-building choices and whether regret was associated with parental role, family-building paths, or outcomes. METHODS This longitudinal mixed methods study included women and their partners who completed a questionnaire prior to their initial consultation with a reproductive specialist and 6 years later. The six-year questionnaire included the Ottawa Decision Regret Scale referencing "the decisions you made about how to add a child to your family." A score of 25+ indicates moderate-to-severe regret. Additional items invited reflections on family-building decisions, treatments, and costs. A systematic content analysis assessed qualitative themes. RESULTS Forty-five couples and 34 individuals participated in the six-year questionnaire (76% retention rate), Half (n = 61) of participants expressed no regret, which was similar by role (median 0 for women and supporting partners, F = .08; p = .77). One in 5 women and 1 in 7 partners expressed moderate-to-severe regret. Women who did not pursue any treatment had significantly higher regret (median 15; F = 5.6, p < 0.01) compared to those who pursued IVF (median 0) or other treatments (median 0). Women who did not add a child to their family had significantly higher regret (median 35; F = 10.1, p < 0.001) than those who added a child through treatment (median 0), through fostering/adoption (median 0), or naturally (median 5). Among partners, regret scores were not associated with family-building paths or outcomes. More than one-quarter of participants wished they had spent less money trying to add a child to their family. Qualitative themes included gratitude for parenthood despite the burdensome process of family-building as well as dissatisfaction or regret about the process. Results should be confirmed in other settings to increase generalizability. CONCLUSION This longitudinal study provides new insight into the burden of infertility. For women seeking parenthood, any of the multiple paths to parenthood may prevent future decision regret. Greater psychosocial, financial, and decision support is needed to help patients and their partners navigate family-building with minimal regret.
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Affiliation(s)
- Rachel Cusatis
- Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, USA.
| | - Colin Johnson
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Katherine D Schoyer
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, USA
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, USA
| | - Joanna Balza
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, USA
| | - Jay Sandlow
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, USA
- Department of Urology, Medical College of Wisconsin, Milwaukee, USA
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, USA
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Selter JH, Woodward J, Neal S. Survey assessing policies regarding patient age and provision of fertility treatment in the United States. J Assist Reprod Genet 2023; 40:2117-2127. [PMID: 37405682 PMCID: PMC10440322 DOI: 10.1007/s10815-023-02877-x] [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: 01/05/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE To determine what policies exist regarding age and provision of fertility treatment in United States fertility clinics. METHODS Medical directors of the Society for Assisted Reproductive Technology (SART) member clinics were surveyed regarding clinic demographics and current policies pertaining to age and provision of fertility treatment. Univariate comparisons were performed using Chi-square and Fisher exact tests as appropriate, with significance set at P ≤ 0.05. RESULTS Of the 366 clinics surveyed, 18.9% (69/366) responded. A majority of clinics who responded 88.4% (61/69) reported having a policy regarding patient age and provision of fertility treatment. Responding clinics with an age policy did not differ from those without a policy on the basis of geographical location, (p = 0.5), insurance mandate status (p = 0.9), practice type (p = 0.4), or annual number of ART cycles (p = 0.7). Of all clinics who responded, 73.9% (51/69) had a maximum maternal age for autologous IVF, with a median of 45 years (range 42-54). Similarly, 79.7% (55/69) of responding clinics had a maximum maternal age for donor oocyte IVF, with a median of 52 years (range 48-56). Slightly under half, 43.4% (30/69) of responding clinics had a maximum maternal age for fertility treatment other than IVF (including ovulation induction or ovarian stimulation with or without IUI) with a median of 46 years (range 42-55). Of note, only 4.3% (3/69) of responding clinics had a policy with respect to maximum paternal age, with a median of 55 years (range 55-70). The most commonly cited reasons for having an age-limit policy were maternal risks of pregnancy, lower ART success rates, fetal/neonatal risks, and concerns about patients' ability to parent at an older age. More than half 56.5% (39/69) of responding clinics reported making exceptions to these policies, most commonly for patients who have pre-existing embryos. The majority of medical directors who responded to the survey believed there should be an ASRM guideline regarding maximum maternal age for autologous IVF 71% (49/69), donor oocyte IVF 78% (54/69) and other fertility treatments 62% (43/69). CONCLUSIONS Most fertility clinics who responded to this national survey reported having a policy regarding maternal age (but not paternal age) and provision of fertility treatment. Policies were based on risk of maternal/fetal complications, lower success rates at older age, and concerns about patients' ability to parent at an older age. The majority of medical directors of responding clinics believed there should be an ASRM guideline regarding age and provision of fertility treatment.
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Affiliation(s)
- Jessica H Selter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Julia Woodward
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Shelby Neal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA
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Yifei Huang E, Hansen AV, Tidemandsen C, la Cour Freiesleben N, Nielsen HS, Backer V, Ulrik CS. Anxiety and depression in women with asthma prior to fertility treatment. Eur Clin Respir J 2023; 10:2221376. [PMID: 37313367 PMCID: PMC10259298 DOI: 10.1080/20018525.2023.2221376] [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: 03/08/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
Objective We investigate symptoms of anxiety and depression among women with asthma prior to fertility treatment. Methods This is a cross-sectional study of women screened for eligibility to the PRO-ART study (RCT of omalizumab versus placebo in asthmatic women undergoing fertility treatment (NCT03727971)). All participants were scheduled for in vitro fertilization (IVF) treatment at four public fertility clinics in Denmark. Data on demographics and asthma control (ACQ-5) were obtained. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS-A and D, respectively) and defined as being present on both subscales if a score >7 was obtained. Spirometry, diagnostic asthma test, and measurement of fractional exhaled nitric oxide (FeNO) were conducted. Results A total of 109 women with asthma were included (mean age 31.8 ± 4.6 and BMI 25.5 ± 4.6). Most women had male factor infertility (36.4%) or unexplained infertility (35.5%). Twenty-two percent of the patients reported uncontrolled asthma (ACQ-5 score > 1.5). The mean HADS-A and HADS-D scores were 6.0 ± 3.8 (95% CI 5.3-6.7) and 2.5 ± 2.2 (95% CI 2.1-3.0), respectively. Thirty (28.0%) women reported anxiety symptoms, and four (3.7%) had concomitant depressive symptoms. Uncontrolled asthma was significantly associated with both depressive (p = 0.04) and anxiety symptoms (p = 0.03). Conclusions More than 25% of women with asthma prior to fertility treatment had self-reported symptoms of anxiety, and just below 5% had self-reported depressive symptoms, possibly related to uncontrolled asthma.
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Affiliation(s)
- Emilia Yifei Huang
- Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark
| | - Anne Vejen Hansen
- Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark
| | - Casper Tidemandsen
- Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark
| | - Nina la Cour Freiesleben
- Department of Obstetrics and Gynaecology, the Fertility Clinic, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynaecology, the Fertility Clinic, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Otorhinolaryngology and Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Buhl Borgstrøm M, Willum Adrian S, Nøhr B, Peters Michaelsen M, Cæcilie Nielsen L, Bruun Gyldenvang M, Schiøler Kesmodel U. Patient attitudes towards and satisfaction with subcutaneous injection of progesterone versus vaginal administration in assisted reproductive technology treatment. Eur J Obstet Gynecol Reprod Biol 2023; 287:1-7. [PMID: 37269751 DOI: 10.1016/j.ejogrb.2023.05.032] [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: 02/21/2023] [Revised: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
The hormones used in fertility treatment come in various forms. Progesterone used for luteal phase support is often administered vaginally as either suppositories, tablets or gel. However, in Denmark the administration of progesterone as a subcutaneous injection has newly been introduced. The aim of the study was to explore patient attitudes towards and satisfaction with subcutaneous injection of progesterone versus vaginal administration of progesterone in Assisted Reproductive Technology (ART) treatments. METHODS AND ANALYSIS A qualitative study with online and face to face interviews with a total of 19 women undergoing an ART treatment. Only women with at least one previous blastocyst transfer using vaginal progesterone or subcutaneous progesterone could be recruited. All participants were included from either the Fertility Clinic at Copenhagen University Hospital - Herlev and Gentofte or from the Fertility Unit at Aalborg University Hospital. RESULTS The analysis resulted in four themes: (1) medication, (2) everyday life, (3) bodily experiences and (4) infertility or hope. Most informants highlighted the administration of subcutaneous progesterone only once a day and avoidance of the vaginal discharge as clear advantages. Reasons for preferring the vaginal administration were inconvenience of bringing the subcutaneous medication along and resistance to inject oneself. CONCLUSION The findings of this study suggest that the satisfaction with the subcutaneous progesterone is generally positive. However, valuable thoughts have given insights into possible areas, which could be improved. Further, that some women prefer vaginal progesterone. The results show that the women are interested in being included in the decision-making when choosing the administration form of progesterone.
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Affiliation(s)
- Maria Buhl Borgstrøm
- The Fertility Clinic, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
| | | | - Bugge Nøhr
- The Fertility Clinic, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | | | | | - Ulrik Schiøler Kesmodel
- The Fertility Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
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Adams A, Adams C. Ovarian Hyperstimulation Syndrome: A Case Report. J Emerg Nurs 2023; 49:8-11. [PMID: 36581393 DOI: 10.1016/j.jen.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ovarian hyperstimulation syndrome is a rare, life-threatening obstetric emergency. Early recognition and prompt treatment of ovarian hyperstimulation syndrome are essential owing to the risk of long-term complications associated with this condition. CASE PRESENTATION A 30-year-old female presented to the emergency department with a chief complaint of abdominal pain. After assessment and diagnostic testing, she was diagnosed as having ovarian hyperstimulation syndrome. The patient was admitted for 24-hour observation. The patient was discharged home with instructions to follow up with an outpatient reproductive medicine clinic. One month after her visit to the emergency department, the patient has not had any complications related to the diagnosis. CONCLUSION This manuscript outlines the case of a patient presenting to the emergency department with ovarian hyperstimulation syndrome that was promptly recognized and treated. It is important for emergency nurses to quickly identify the risk factors and clinical presentation of ovarian hyperstimulation syndrome to decrease the risk of long-term complications.
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Luyten J, Connolly MP, Verbeke E, Buhler K, Scotland G, Lispi M, Revelli A, Borget I, Cedrin-Durnerin I, D'Hooghe T. Economic evaluation of Medically Assisted Reproduction: An educational overview of methods and applications for healthcare professionals. Best Pract Res Clin Obstet Gynaecol 2022; 85:217-228. [PMID: 35219590 DOI: 10.1016/j.bpobgyn.2022.01.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/11/2022] [Indexed: 12/14/2022]
Abstract
Economic evaluations of the value-for-money of Medically Assisted Reproduction (MAR) interventions are increasingly important due to growing pressure on healthcare budgets. Although such evaluations are commonplace in the published literature, the number/methodological complexity of different evaluations available, and the challenges specific to MAR interventions, can complicate the interpretation of such analyses for fertility treatments. This article aims to serve as an educational resource and provide context on the design/interpretation of economic analyses for MAR interventions. Several areas are relevant for first-line providers and decision makers: scope of analysis, comparator used, perspective/time horizon considered, outcomes used to measure success, and how results from cost-effectiveness studies can be summarised and used in clinical practice. We aim to help clinicians better understand the strengths/weaknesses of economic analyses, to enable the best use of the evidence in practice, so resources available for MAR interventions can provide maximum value to patients and society.
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Affiliation(s)
- Jeroen Luyten
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35, B-3000, Leuven, Belgium.
| | - Mark P Connolly
- Global Market Access Solutions Sarl, Route de Buchillon, 65 St-Prex 1162, Switzerland; Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands.
| | - Evelyn Verbeke
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35, B-3000, Leuven, Belgium.
| | - Klaus Buhler
- Scientific Clinical Centre for Endometriosis, University Hospitals of Saarland, Saarbrüken, Germany; Department of Gynaecology, Jena-University Hospital-Friedrich Schiller University, 07737, Jena, Germany.
| | - Graham Scotland
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK; Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Monica Lispi
- Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany; School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Via Campi N. 287, 41125, Modena, Italy.
| | - Alberto Revelli
- SCDU2 Obstetrics and Gynecology, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Via Ventimiglia 1, 10126, Turin, Italy.
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Oncostat U1018, Inserm, Labeled Ligue Contre le Cancer Gustave Roussy, University Paris-Saclay, 114, rue Édouard-Vaillant, Villejuif Cedex, 94805, France; EA GRADES, University Paris-Saclay, Bâtiment B, 5 ue Jean-Baptiste Clément, 92296, Châtenay-Malabry Cedex, France.
| | - Isabelle Cedrin-Durnerin
- AP-HP- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, July 14th Avenue, 93140, Bondy, France.
| | - Thomas D'Hooghe
- Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, B-3000, Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, CT, 06510, USA.
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Bhaduri M, Gama RM, Copeland T, Balagamage A, Patel P, Warmington E, Sarris I, Nicholaides K, Bramham K. Systematic review of pregnancy and renal outcomes for women with chronic kidney disease receiving assisted reproductive therapy. J Nephrol 2022; 35:2227-36. [PMID: 36396849 DOI: 10.1007/s40620-022-01510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND As awareness around infertility is increasing among patients with chronic kidney disease (CKD), ever more of them are seeking Assisted Reproductive Technology (ART). Our aim was to perform a systematic review to describe obstetric and renal outcomes in women with CKD following ART. METHODS The following databases were searched from 1946 to May 2021: (1) Cochrane Central Register of Controlled Trials (CENTRAL), (2) Cumulative Index to Nursing and Allied Health Literature (CINAHL), (3) Embase and (4) MEDLINE. RESULTS The database search identified 3520 records, of which 32 publications were suitable. A total of 84 fertility treatment cycles were analysed in 68 women. Median age at time of pregnancy was 32.5 years (IQR 30.0, 33.9 years). There were 60 clinical pregnancies resulting in 70 live births (including 16 multifetal births). Four women developed ovarian hyperstimulation syndrome which were associated with acute kidney injury. Hypertensive disorders complicated 26 pregnancies (38.3%), 24 (35.3%) pregnancies were preterm delivery, and low birth weight was present in 42.6% of pregnancies. Rates of live birth and miscarriage were similar for women with CKD requiring ART or having natural conception. However, more women with ART developed pre-eclampsia (p < 0.05) and had multifetal deliveries (p < 0.001), furthermore the babies were lower gestational ages (p < 0.001) and had lower birth weights (p < 0.001). CONCLUSION This systematic review represents the most comprehensive assessment of fertility outcomes in patients with CKD following ART. However, the high reported live birth rate is likely related to reporting bias. Patient selection remains crucial in order to maximise patient safety, screen for adverse events and optimise fertility outcomes.
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11
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Payne N, van den Akker O. Mental health and coping with fertility treatment cessation during the COVID-19 pandemic in the UK. J Psychosom Obstet Gynaecol 2022; 43:550-556. [PMID: 35833417 DOI: 10.1080/0167482x.2022.2097475] [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: 10/17/2022] Open
Abstract
PURPOSE This study examined experiences during the cessation of fertility treatment due to the COVID-19 pandemic, including levels of mental health, coping strategies used to manage uncertainty about treatment due to the pandemic, sources of support, and predictors of mental health. METHODS One hundred and seventy-five participants in the UK completed an online survey. RESULTS Half of the participants experienced clinical levels of anxiety and/or depression, and 20% reported suicidal feelings as a result of the uncertainty about treatment due to the pandemic. Support from friends, family and online forums were reported by more than half of participants, but support from fertility clinics or counsellors were reported by less than one quarter. The strategy used most frequently to cope with the uncertainty about treatment due to the pandemic was self-distraction, and this predicted reduced depression. However, self-blame, behavioral disengagement and venting predicted increased depression and self-blame, behavioral disengagement, and denial predicted increased anxiety. CONCLUSIONS Fertility clinic communication and psychological support, such as counselling, which had substantially reduced during treatment cessation, could include some focus on personal coping, including what to avoid. Psychological support is likely to be more important now than ever. Despite resumption of treatment, the impacts of the period of cessation and of COVID-19 are likely to continue to reverberate.
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Affiliation(s)
- Nicola Payne
- Department of Psychology, Middlesex University, London, UK
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12
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Everhøj C, Norsker FN, Rechnitzer C, Licht SDF, Nielsen TT, Kjær SK, Jensen A, Hargreave M, Christensen J, Belmonte F, Urhoj SK, Strandberg-Larsen K, Winther JF, Kenborg L. Effects of early maternal cancer and fertility treatment on the risk of adverse birth outcomes. EClinicalMedicine 2022; 46:101369. [PMID: 35399810 PMCID: PMC8987408 DOI: 10.1016/j.eclinm.2022.101369] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Early maternal cancer and fertility treatment each increase the risk for adverse birth outcomes, but the joint effect of these outcomes has not yet been reported. Thus, the aim was to assess the individual and joint effect of maternal cancer and fertility treatment on the risk for adverse birth outcomes. METHODS This population-based cohort study included 5487 live-born singletons identified in the Danish Medical Birth Register (1994-2016) of mothers with previous cancer (<40 years) recorded in the Danish Cancer Registry (1955-2014). We randomly selected 80,262 live-born singletons of mothers with no cancer <40 years matched to mothers with cancer by birth year and month. We calculated odds ratios (ORs) for preterm birth, low birth weight (LBW) (<2500 g) and small for gestational age (SGA), mean differences in birth weight in grams, and additional cases of preterm birth (gestational age<259 days) per 100,000 person-years. Multiplicative and additive interaction of maternal cancer and fertility treatment was compared with outcomes of children conceived naturally to mothers with no maternal cancer (reference group). FINDINGS Among 84,332 live-born singletons, increased ORs for preterm birth were observed among children born to mothers with previous cancer (1·48, 95% confidence interval [CI] 1·33-1.65) or after fertility treatment (1·43, 95% 1·28-1-61), with 22 additional cases of preterm birth among both group of children (95% CI 15-29; 95% CI 14-30). In the joint analyses, the OR for SGA for children born after fertility treatment to mothers with previous cancer was similar to that of the reference group (OR 1·02, 95% CI 0·72-1·44, P for interaction=0·52). Children with both exposures had increased ORs for LBW (1·86, 95% CI 1·17-2·96, P for interaction=0·06) and preterm birth (2·31, 955 CI 1·66-3·20, P for interaction = 0·56), with 61 additional cases of preterm birth (95% CI 27-95, P for interaction=0.26) over that of children in the reference group. The mean birth weight was also lower in children born to mothers with both exposures (-140 g, 95% CI -215; -65) (P for interaction=0.06) but decreased to -22 g (95% CI -76; 31) after adjustment for GA. INTERPRETATION Although we did not find any statistically significant additive interaction between maternal cancer and fertility treatment, children born after fertility treatment of mothers with previous cancer were at increased risk for adverse birth outcomes. Thus, pregnant women with both exposures need close follow-up during pregnancy. FUNDING The Danish Cancer Society and the Danish Childhood Cancer Foundation.
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Affiliation(s)
- Cathrine Everhøj
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen 2100, Denmark
| | - Filippa Nyboe Norsker
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen 2100, Denmark
| | - Catherine Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sofie de Fine Licht
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen 2100, Denmark
| | - Thomas T Nielsen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen 2100, Denmark
| | - Susanne K. Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Jensen
- Lifestyle, Reproduction and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marie Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jane Christensen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Stine Kjaer Urhoj
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | | | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen 2100, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen 2100, Denmark
- Corresponding author.
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13
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Glatthorn HN, Decherney A. The efficacy of add-ons: selected IVF "add-on" procedures and future directions. J Assist Reprod Genet 2022; 39:581-589. [PMID: 35066700 PMCID: PMC8995402 DOI: 10.1007/s10815-022-02410-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/05/2021] [Accepted: 01/19/2022] [Indexed: 01/04/2023] Open
Abstract
Since the advent of ART, technology has continuously evolved to improve embryology and pregnancy outcomes. However, not all technologies that are integrated into practice have convincing evidence of clinical effectiveness, and they often increase the financial burden of fertility care. We discuss here a selection of commonly utilized IVF "add-ons" and discuss the existing evidence for their utility. The procedures included in this review are time-lapse imaging of embryos, assisted hatching, EmbryoGlue, sperm DNA testing, egg activation with calcium ionophore, endometrial receptivity array, and physiological intracytoplasmic sperm injection (PICSI). While there is rather limited supporting evidence for nearly all IVF add-ons that we reviewed, there is strong demand from patients, physicians, and the biotechnology industry to continue further research and development in this arena. We propose that all add-on procedures should provide true efficacy for the patient, and reproductive endocrinologists should inform patients of the costs and benefits of utilizing various technologies before they undergo treatment. In the future, add-ons that show clear evidence of efficacy and justifiable cost should be incorporated into routine practice, while others that do not meet these criteria should be phased out entirely.
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Affiliation(s)
- Haley N. Glatthorn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, Room 2133, New Brunswick, NJ 08901 USA
| | - Alan Decherney
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Hatfield Clinical Research Center, 10 Center Drive, Room 5-5570, Bethesda, MD 20892 USA
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14
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Hecht LM, Hadwiger A, Patel S, Hecht BR, Loree A, Ahmedani BK, Miller-Matero LR. Disordered eating and eating disorders among women seeking fertility treatment: A systematic review. Arch Womens Ment Health 2022; 25:21-32. [PMID: 34175997 DOI: 10.1007/s00737-021-01156-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 03/21/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.
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Affiliation(s)
- Leah M Hecht
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.
| | - Ashley Hadwiger
- Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Shivali Patel
- Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Bryan R Hecht
- MetroHealth Medical Center, Division of Reproductive Endocrinology, 2500 Metrohealth Dr, Cleveland, OH, 44109, USA
| | - Amy Loree
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA
| | - Brian K Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.,Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Lisa R Miller-Matero
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.,Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
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15
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Jaiswal P, Mahey R, Singh S, Vanamail P, Gupta M, C R, Sharma JB, Bhatla N. Psychological impact of suspension/postponement of fertility treatments on infertile women waiting during COVID pandemic. Obstet Gynecol Sci 2022. [PMID: 35045244 DOI: 10.5468/ogs.21254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the psychological impact of suspension/postponement of various fertility treatments on infertile women during the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a cross-sectional study conducted as an online survey among infertile women consulting either through teleconsultation or physical consultation at a fertility clinic of a tertiary care referral unit. A validated questionnaire was given as a WhatsApp link to the women who were consulting for the resumption of services. Questions asked were based on their socio-demographic parameters, fertility treatment at the time of suspension, anxiety (self-reported) and stress (perceived stress scale-4, PSS-4) due to delay in treatment, psychosocial effect of pandemic, and wishes regarding the resumption of fertility services. Results Of 430 patients who received the questionnaire, 250 completed the survey (response rate: 58%). The mean age of participants was 29.26±4.18 years and the majority (70.4%) had lower socioeconomic status. The average PSS-4 score was 7.8±0.71, and the prevalence of self-reported anxiety was 72%. Those who suffered migration during the pandemic had significantly higher PSS-4 scores, and increasing age was associated with increased self-reported anxiety due to the suspension of fertility services. The top three priorities reported were infertility and treatment delay (48.4%), job loss (19.2%), and the risk of contracting COVID-19 infection (16%). The degree of spousal support was significantly correlated with lower PSS-4 scores (r=−0.30, P<0.01). On multivariate logistic analysis, duration of infertility, delay in treatment due to suspension of services, and fear of COVID-19 infection were significant predictors of stress and anxiety. Conclusion This study emphasizes the need to investigate psychosocial health and to provide psychological support to this vulnerable population in addition to triaging fertility treatments in a phased manner.
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16
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Abstract
Headlines have appeared across multiple social media platforms questioning the effects of newly authorised COVID-19 vaccines on fertility. Although the effects on future fertility were not studied in the initial trials, at present, there is no evidence that the COVID-19 vaccine has any effect of future fertility. It is well known that pregnant women are at a higher risk of complications associated with COVID-19 such as ICU admission and death, and there is a rare but tragic increase in placentitis and stillbirth, highlighting the importance for those planning a pregnancy any time in the future to be vaccinated. Here we summarise international consensus from multiple organisations advising on fertility and the COVID-19 vaccine. Preliminary studies all suggest that there is neither link, nor indeed any theoretical reason why any of the COVID-19 vaccines might affect fertility. Dissemination of misinformation regarding the impact of the vaccine on future fertility needs to be controlled in order to avoid any hesitancy amongst young women attending for vaccination. It is also vital that the medical profession counteract this information, and, in order to do that, healthcare providers must be well informed on the latest recommendations and research.
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Affiliation(s)
- Laurentina Schaler
- Merrion Fertility Clinic, 60 Lower Mount Street, Dublin 2, Ireland.
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
- School of Medicine, University College Dublin, Dublin 4, Ireland.
| | - Mary Wingfield
- Merrion Fertility Clinic, 60 Lower Mount Street, Dublin 2, Ireland
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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17
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Yariv O, Mutai R, Rotem O, Tsoref D, Korzets Y, Moore A, Shochat T, Yerushalmi R, Goldvaser H. The Impact of Exogenous Estrogen Exposure on the Characteristics and Outcome of Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Early-Stage Breast Cancer. Oncology 2021; 99:713-721. [PMID: 34515186 DOI: 10.1159/000518183] [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: 05/09/2021] [Accepted: 06/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The impact of exogenous estrogen exposure on breast cancer characteristics and outcomes is not well described. We aimed to investigate the effect of prior treatment with oral contraceptives (OCT), hormone replacement therapy (HRT), and fertility treatments on early-stage, estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. METHODS This is a single-center retrospective cohort study comprising all women with ER-positive, HER2-negative, early breast cancer whose tumors were sent to Oncotype DX analysis between 2005 and 2012. Data on prior exposures to OCT, HRT, and fertility treatments were collected. The impact of these exposures on prespecified histopathological features was assessed including tumor size, nodal status, intensity of the hormonal receptors, grade, Oncotype recurrence score, Ki67, and lymphovascular and perineural invasion. The impact of these exposures on disease-free survival (DFS) and overall survival (OS) was also evaluated. RESULTS A total of 620 women were included, of which 19% had prior exposure to OCT, 30% to HRT, and 11% to fertility treatments. OCT use was associated with smaller (≤1 cm) tumors (p = 0.023) and were less likely to have grade 3 disease (p = 0.049). No other associations were found between exogenous estrogen exposure and tumor characteristics. Median follow-up was 10.4 years. Ten-year DFS was 85.7%, and it was not influenced by exogenous exposure. Ten-year OS was 90.2%, and OCT was associated with improved OS in univariate analysis (HR = 0.31, 95% CI: 0.11-0.85), but this difference did not remain significant in multivariate analysis (p = 0.275). CONCLUSION The impact of exogenous estrogen exposure on ER-positive, HER2-negative early breast cancer characteristics is limited. In the long term, none of the evaluated exposures had negative effect on DFS and OS.
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Affiliation(s)
- Orly Yariv
- Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Raz Mutai
- Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Rotem
- Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daliah Tsoref
- Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Korzets
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Assaf Moore
- Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel.,Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, Petah Tikva, Israel
| | - Rinat Yerushalmi
- Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Goldvaser
- Shaare Zedek Medical Center, Oncology Institute, Jerusalem, Israel.,The Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Abstract
When working with LGBTQ+ patients who want to build families, primary care providers play a key role in increasing access to reproductive health care. There is growing demand for assisted reproductive services among LGBTQ+ individuals who do not already have their own children or do not wish to adopt. Fertility-preservation options are available for transgender patients; however, many of these treatments are inaccessible to patients because of lack of insurance coverage and high cost. Legal options for LGBTQ+ patients' reproduction vary by state. Knowledge of the laws and regulations in your own state of practice is necessary to manage expectations.
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Affiliation(s)
- Melissa N Montoya
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Benjamin J Peipert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Dane Whicker
- Department of Psychiatry and Behavioral Sciences, 2213 Elba Street, Durham, NC 27710, USA
| | - Beverly Gray
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA.
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19
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Leeners B, Krüger T, Geraedts K, Tronci E, Mancini T, Ille F, Egli M, Röblitz S, Wunder D, Saleh L, Schippert C, Hengartner MP. Cognitive function in association with high estradiol levels resulting from fertility treatment. Horm Behav 2021; 130:104951. [PMID: 33561436 DOI: 10.1016/j.yhbeh.2021.104951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/17/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
The putative association between hormones and cognitive performance is controversial. While there is evidence that estradiol plays a neuroprotective role, hormone treatment has not been shown to improve cognitive performance. Current research is flawed by the evaluation of combined hormonal effects throughout the menstrual cycle or in the menopausal transition. The stimulation phase of a fertility treatment offers a unique model to study the effect of estradiol on cognitive function. This quasi-experimental observational study is based on data from 44 women receiving IVF in Zurich, Switzerland. We assessed visuospatial working memory, attention, cognitive bias, and hormone levels at the beginning and at the end of the stimulation phase of ovarian superstimulation as part of a fertility treatment. In addition to inter-individual differences, we examined intra-individual change over time (within-subject effects). The substantial increases in estradiol levels resulting from fertility treatment did not relate to any considerable change in cognitive functioning. As the tests applied represent a broad variety of cognitive functions on different levels of complexity and with various brain regions involved, we can conclude that estradiol does not show a significant short-term effect on cognitive function.
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Affiliation(s)
- Brigitte Leeners
- Department of Reproductive Endocrinology, University hospital Zürich, 8910 Zurich, Frauenklinikstr. 10, Switzerland.
| | - Tillmann Krüger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany.
| | - Kirsten Geraedts
- Department of Reproductive Endocrinology, University hospital Zürich, 8910 Zurich, Frauenklinikstr. 10, Switzerland.
| | - Enrico Tronci
- Department of Computer Science, University of Roma "La Sapienza", Roma, Italy.
| | - Toni Mancini
- Department of Computer Science, University of Roma "La Sapienza", Roma, Italy.
| | - Fabian Ille
- Center of Competence in Aerospace Biomedical Science & Technology, Lucerne University of Applied Sciences and Arts, Hergiswil, Switzerland.
| | - Marcel Egli
- Center of Competence in Aerospace Biomedical Science & Technology, Lucerne University of Applied Sciences and Arts, Hergiswil, Switzerland.
| | - Susanna Röblitz
- Computational Biology Unit, Department of Informatics, University of Bergen, Bergen, Norway.
| | - Dorothea Wunder
- Center for Reproductive Medicine and Gynecological Endocrinology, Lausanne, Switzerland.
| | - Lanja Saleh
- Institute of Clinical Chemistry, University hospital Zürich, Zürich, Switzerland.
| | - Cordula Schippert
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany.
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University for Applied Sciences (ZHAW), Zürich, Switzerland.
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20
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Katyal N, Poulsen CM, Knudsen UB, Frederiksen Y. The association between psychosocial interventions and fertility treatment outcome: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 259:125-132. [PMID: 33677371 DOI: 10.1016/j.ejogrb.2021.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/16/2020] [Revised: 01/28/2021] [Accepted: 02/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Does psychosocial intervention affect pregnancy outcomes in women and couples undergoing assisted reproductive technology (ART) treatment?. DESIGN A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) evaluating the efficacy of psychosocial intervention on pregnancy outcomes in women and couples undergoing ART treatment. The primary outcome was Pregnancy Rates. Secondary outcomes were Live Birth Rate (LBR) and Abortion Rate (AR). MATERIALS AND METHODS Databases searched were Pubmed, PsycINFO, Embase, CINAHL and The Cochrane Library. 1439 records were screened, 15 were eligible and included in the meta-analyses (N = 2434). Data was extracted using the Covidence software. Effect sizes were reported as relative risks with 95% confidence-intervals and p-values. RESULTS A positive association was found between psychosocial intervention and pregnancy rates (RR = 1.12 CI=(1.01;1.24), p = 0.033). Long-duration interventions and mind-body intervention types were found to be associated with increased pregnancy rates (RR 1.21, CI= (1.04;1.43), p = 0.017) and (RR = 1.25, CI= (1.00;1.55), p = 0.046) respectively. Q and I2tests suggested no to low heterogeneity. Funnel plots, Trim and Fill analyses and Fail-safe numbers were applied to adjust for possible publication bias. CONCLUSIONS Our findings suggest a positive association between psychosocial interventions, particularly long-duration interventions, and pregnancy rate in infertile women and couples in ART treatment. The findings are in line with findings from other reviews and meta-analyses exploring the same topic. More good quality RCTs need to be performed to increase the quality of guidance for infertile women and couples. The effect of psychosocial interventions on LBR and AR remain to be examined.
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Affiliation(s)
- Nitasha Katyal
- Department of Health, Aarhus University, 8000 Aarhus C, Denmark.
| | | | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; The Fertility Clinic, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Yoon Frederiksen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; the Sexology Unit, Aarhus University Hospital Psychiatry, 8200 Aarhus N, Denmark
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Passet-Wittig J, Greil AL. Factors associated with medical help-seeking for infertility in developed countries: A narrative review of recent literature. Soc Sci Med 2021; 277:113782. [PMID: 33895708 DOI: 10.1016/j.socscimed.2021.113782] [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] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
The reasons why people decide for or against seeking medical help for infertility are still far from clear. With advances in reproductive medicine, use of medically-assisted reproduction has increased over the last three decades. Over the same period, an appreciable amount of quantitative studies on the determinants of medical help-seeking for infertility has accumulated. However, to our knowledge this narrative review is the first to summarize and evaluate findings from these studies. This review includes 39 studies carried out in 11 countries, covering the period 1990-2019. We have identified five categories of determinants of help-seeking: socio-demographic variables, socio-economic factors, reproductive history, attitudes, and psychological factors. Each category consists of several variables. Considerable knowledge has accumulated on socio-economic variables, indicating that there is social inequality in access to treatments in several countries. Less is known about marital status, attitudes and psychological factors. Findings on the latter two mostly derive from two US surveys. Overall, the body of research appears heterogeneous and fragmented. Studies differ in central aspects of study design (definitions of the analysis sample and of help-seeking, type of analysis (bivariate or multivariate), set of variables included in multivariate studies) making comparisons of findings difficult. Low comparability is reinforced by country differences in the provision of treatment, legislation on access and treatment coverage. The majority of papers lack a theoretical foundation or reference to any theory. Using a theoretical framework to guide empirical research could help to overcome the problems described above. Single-country studies should include information on legal and cultural context. More studies from countries other than the US are needed as well as multi-country studies in order to develop a systematic understanding of how macro-level structures relate to decisions about medical help-seeking. This review should assist future researchers in their attempt to conduct studies on help-seeking for infertility.
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Affiliation(s)
- Jasmin Passet-Wittig
- Federal Institute for Population Research, Friedrich-Ebert-Allee 4, 65185, Wiesbaden, Germany.
| | - Arthur L Greil
- Liberal Arts & Sciences, 1 Saxon Drive, Alfred, NY, 14802, Alfred University, USA.
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Wienecke LS, Kjær SK, Frederiksen K, Hargreave M, Dalton SO, Jensen A. Ninth-grade school achievement in Danish children conceived following fertility treatment: a population-based cohort study. Fertil Steril 2021; 113:1014-1023. [PMID: 32386613 DOI: 10.1016/j.fertnstert.2020.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/17/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess whether academic achievement among children conceived following fertility treatment is different from that of children born to fertile women while also considering the underlying infertility. DESIGN Population-based cohort study. SETTING Denmark. PATIENT(S) The study population consisted of all 154,536 firstborn, live-born, singleton children in Denmark between 1995 and 2000 who completed their ninth grade with an examination. INTERVENTION(S) The Danish Infertility Cohort was used to identify children conceived after fertility treatment (n = 10,099), and information on mean school marks was obtained from Statistics Denmark. MAIN OUTCOME MEASURE(S) Linear regression models were used to estimate mean differences (MDs) and 95% confidence intervals (CIs). Multiple logistic regression models were used to estimate odds ratios (OR) and 95% CI of not passing the ninth-grade examination. RESULTS The crude overall mean marks for children conceived after the various fertility treatment procedures were in general higher than in children born to fertile women. However, after adjustment for potential confounders, the overall mean marks were statistically significantly lower for children conceived after the various fertility treatment procedures (e.g., any fertility treatment: MD -0.13; 95% CI -0.18, -0.08) compared with children born to fertile women. Further, children conceived after any fertility treatment had a statistically significant lower crude likelihood of not passing the ninth-grade examination (OR 0.66; 95% CI 0.53, 0.81) compared with children born to fertile women, whereas no difference was observed in the confounder adjusted analyses (OR 1.15; 95% CI 0.89, 1.49). When children born to women requiring fertility assistance but without fertility treatment in the index pregnancy were used as a reference group, no differences in the adjusted overall mean marks and the likelihood of not passing the ninth grade with an examination were observed. CONCLUSION Our findings indicate that fertility treatment per se is not associated with lower school marks and the likelihood of not passing the ninth grade with an examination. Hence, we suggest that factors related to both fertility problems and cognitive development may more likely explain the slightly lower academic performance (i.e., modest lower mean marks) among children conceived after fertility treatment.
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Affiliation(s)
- Lisa S Wienecke
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marie Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
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Guleria S, Jensen A, Albieri V, Nøhr B, Frederiksen K, Kjær SK. Endometrial cancer risk after fertility treatment: a population-based cohort study. Cancer Causes Control 2021; 32:181-188. [PMID: 33392904 DOI: 10.1007/s10552-020-01372-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 11/18/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE Using data from a large population-based cohort of women with fertility problems in Denmark, we examined the association between use of fertility drugs and endometrial cancer incidence. METHODS Women aged 20-45 years living in Denmark during 1 January 1995-31 December 2017 and diagnosed with fertility problems (i.e., subfertile women) were identified from the Danish Infertility Cohort. Information on use of fertility drugs, endometrial cancer, covariates and vital status was obtained from various Danish national registers. Cox proportional hazard models were used adjusted for calendar year of study entry, highest level of education, parity status, hormonal contraceptive use, obesity and diabetes mellitus. RESULTS Of the 146,104 subfertile women, 129,478 (88.6%) were treated with fertility drugs. During a median follow-up of 10.1 years, 119 women were diagnosed with endometrial cancer. Use of any fertility drugs was not associated with an increased rate of overall (HR 0.82; 95% CI 0.50-1.34) or type I endometrial cancer (HR 1.08; 95% CI 0.60-1.95). No associations between use of specific types of fertility drugs and endometrial cancer were observed. No marked associations were observed according to cumulative dose of specific fertility drugs, parity status, or with increasing follow-up time. CONCLUSIONS No marked associations between use of fertility drugs and risk of endometrial cancer were observed. The relatively young age of the cohort at end of follow-up, however, highlights the need for longer follow-up of women after fertility drug use.
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Affiliation(s)
- Sonia Guleria
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Vanna Albieri
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Bugge Nøhr
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, University Hospital of Herlev and Gentofte, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark. .,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Ikemoto Y, Kuroda K, Endo M, Tanaka A, Sugiyama R, Nakagawa K, Sato Y, Kuribayashi Y, Tomooka K, Imai Y, Deshpande GA, Tanigawa T, Itakura A, Takeda S. Analysis of severe psychological stressors in women during fertility treatment: Japan-Female Employment and Mental health in Assisted reproductive technology (J-FEMA) study. Arch Gynecol Obstet 2021; 304:253-261. [PMID: 33386414 PMCID: PMC7775729 DOI: 10.1007/s00404-020-05923-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/24/2020] [Indexed: 11/01/2022]
Abstract
PURPOSE To identify risk factors for severe psychological stress in women undergoing fertility treatment. METHODS This cross-sectional, multi-center study was conducted from August to December 2018. We recruited 1672 subjects who completed an anonymous, self-reported questionnaire regarding fertility treatment, conditions at work and home, and psychological stress using K6 score, which estimates psychological distress during the previous 30 days. We further focused our analysis on 1335 subjects who were working when starting fertility treatment. RESULTS Of 1672 women, mean K6 score (range 0-24) was 4.8 ± 4.4, including 103 women (6.2%) with K6 score ≥ 13 (high K6), and classified as probable severe psychological distress. Multivariate logistic regression analysis showed that high K6 was strongly associated with low annual family income of ≤ USD55,700 (JPY6 million) (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.04-3.42), infertility duration of ≥ 2 years (OR 1.87, 95% CI 1.08-3.25), and no experience of childbirth (OR 2.04, 95% CI 1.05-3.97). Focusing on 1335 working women, 266 (19.9%) experienced resignation from work. High K6 was strongly associated with low family income (OR 2.83, 95% CI 1.52-5.28), cessation of professional duties (OR 2.08, 95% CI 1.05-4.14), infertility-related harassment in the workplace (OR 2.07, 95% CI 1.08-3.98), and perceived difficulties to continue working during fertility treatment (OR 2.94, 95% CI 1.15-7.50). CONCLUSION Severe psychological stressors in women during fertility treatment included low family income, long infertility duration, childlessness, infertility-related harassment, and perceived difficulty in working conditions or cessation from work. Establishment of mental health care support systems is urgently required in this population.
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Affiliation(s)
- Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan. .,Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, 1-19-6, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Motoki Endo
- Department of Public Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsushi Tanaka
- Saint Mother Obstetrics and Gynecology Clinic, Institute for ART, Fukuoka, Japan
| | - Rikikazu Sugiyama
- Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, 1-19-6, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Koji Nakagawa
- Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, 1-19-6, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yuichi Sato
- Tatedebari Sato Hospital, Obstetrics and Gynecology, Gunma, Japan.,Takasaki ART Clinic, Gunma, Japan
| | - Yasushi Kuribayashi
- Sugiyama Clinic Marunouchi, Center for Reproductive Medicine and Endoscopy, Tokyo, Japan
| | - Kiyohide Tomooka
- Department of Public Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuya Imai
- Department of Public Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Gautam A Deshpande
- Department of General Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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25
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Zhang Y, Gao R, Chen H, Xu W, Yang Y, Zeng X, Sun X, Zhang S, Hu X, Qin L. The association between fertility treatments and the incidence of paediatric cancer: A systematic review and meta-analysis. Eur J Cancer 2020; 138:133-148. [PMID: 32889368 DOI: 10.1016/j.ejca.2020.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/27/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is important to explore the association between different fertility treatments and the incidence of paediatric cancer, as this will provide crucial guidance for clinical decision-making. Previous studies have explored the relationship between fertility treatments and different types of cancer in offspring, but the results are controversial. METHOD Two authors searched PubMed, Embase, Web of Science and Cochrane databases independently to acquire qualified studies. Then, the same authors extracted data from these studies and analysed these data using RevMan 5.3. MAIN RESULTS Eleven case-control studies and 16 cohort studies were included in this review and meta-analysis. The relative risk of association between in vitro fertilisation (IVF) and paediatric cancer incidence was 1.01 (95% confidence interval [CI]: 0.80-1.28) in cohort studies and 1.09 (95% CI: 0.74-1.58) in case-control studies. The relative risk of association between intracytoplasmic sperm injection (ICSI) and paediatric cancer incidence was 0.97 (95% CI: 0.80-1.17) in cohort studies. The relative risk of association between fertility drugs and paediatric cancer incidence was 1.07 (95% CI: 0.68-1.69) in cohort studies and 1.12 (95% CI: 0.90-1.41) in case-control studies. The relative risk of association between frozen embryo transfer and paediatric cancer incidence was 1.37 (95% CI: 1.04-1.81) in natural pregnancy controls and 1.28 (95% CI: 0.96-1.69) in fresh embryo transfer controls. CONCLUSION There is no evidence that IVF, ICSI and fertility drugs are associated with an increase in paediatric cancer incidence in offspring; however, frozen embryo transfer is associated with an increase in paediatric cancer incidence in the offspring, but this finding needs further research and attention.
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Affiliation(s)
- Yaoyao Zhang
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Rui Gao
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Hanxiao Chen
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Wenming Xu
- SCU-CUHK Joint Laboratory for Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yihong Yang
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xun Zeng
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaochi Sun
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Sirui Zhang
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Xiao Hu
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Lang Qin
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
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26
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Huber D, Seitz S, Kast K, Emons G, Ortmann O. Use of fertility treatments in BRCA1/2 mutation carriers and risk for ovarian and breast cancer: a systematic review. Arch Gynecol Obstet 2020; 302:715-720. [PMID: 32719921 PMCID: PMC7447664 DOI: 10.1007/s00404-020-05690-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Abstract
Purpose Mutations in the genes BRCA1 and BRCA2 represent a significant risk factor for ovarian and breast cancer. With increasing number and success rates, fertility protection and treatment are gaining importance also for BRCA1/2 mutation carriers. However, the effect on primary cancer risk and risk for recurrence remains unclear. This review analyses the published data on fertility treatment and risk of ovarian and breast cancer in BRCA1/2 mutation carriers. Methods In this review, we included all relevant articles published in English from 1995 to 2018. Literature was identified through a search on PubMed and Cochrane Library. Results We identified one retrospective cohort and one case–control study regarding the association of fertility treatments and ovarian cancer risk in BRCA mutation carriers. The studies show no increase in ovarian cancer risk. Furthermore, one case–control study on the association between fertility treatment and breast cancer risk in BRCA mutation carriers and one prospective cohort study on the long-term safety of medication used for fertility preservation in women with a history of breast cancer were identified. One of the studies shows a possible adverse effect for gonadotropin-containing medication. Conclusion Possible increases in cancer risk associated with fertility treatments in BRCA1/2 mutation carriers cannot be excluded at this time. Based on the existing studies, BRCA1/2 mutation carriers should not be generally excluded from fertility treatments. However, they have to be informed about limited data and possible increases in cancer risk.
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Affiliation(s)
- D Huber
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - S Seitz
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - K Kast
- Department of Gynecology and Obstetrics, Medical Faculty, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - G Emons
- Department of Gynecology and Obstetrics, Georg August University Göttingen, University Medicine, Göttingen, Germany
| | - O Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany.
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Whittier Olerich K, Summers K, Lewis AM, Stewart K, Ryan GL. Patient identified factors influencing decisions to seek fertility care: adaptation of a wellness model. J Reprod Infant Psychol 2019; 39:263-275. [PMID: 31856599 DOI: 10.1080/02646838.2019.1705263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To adapt a fertility care wellness model.Background: Despite availability of a range of diagnostic and therapeutic services for infertility, many do not seek care or discontinue care prior to achieving a live birth. Wellness models can inform research on patient decisions to seek and continue fertility care, as many barriers and drivers are represented within the dimensions of wellness.Methods: A mixed-methods online survey was completed by 135 people of reproductive age who experienced infertility in the USA. Outcomes included drivers and barriers to seeking or continuing fertility care. Identified factors were compared by treatment history using chi-square and Fisher's exact tests. Themes and patterns were identified within 174 responses to 6 open-response items through conventional content analysis.Results: Thematic analysis revealed practical (environmental, financial, and physical) and affective (emotional, social and spiritual) dimensions of wellness in decisions to seek care (67%), with affective rationales more prominent in decisions to return for care (78%).Conclusion: Decisions to seek fertility care and return after failed treatment integrate practical and affective rationales from financial, physical, environmental, emotional, social and spiritual wellness dimensions. Drivers and barriers within these dimensions should be considered to encourage care seeking and improve patient retention.
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Affiliation(s)
- Kelsey Whittier Olerich
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Karen Summers
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Adam M Lewis
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kathleen Stewart
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA
| | - Ginny L Ryan
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Côté A, Maheux-Lacroix S, Sabr Y, Gasse C, Bujold E, Boutin A. Association between fertility treatments and early placentation markers. Placenta 2019; 82:35-41. [PMID: 31174624 DOI: 10.1016/j.placenta.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 02/28/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Pregnancies resulting from fertility treatments are at higher risk of placenta-mediated complications. Hence, we aimed to estimate the association between fertility treatment and levels of first-trimester markers of placentation. METHODS We conducted a cohort study in an academic center from 03/2011 to 12/2014. Adult nulliparous women with singleton pregnancies were recruited between 11 + 0 and 13 + 6 weeks of gestation. Data on maternal characteristics, medical history, and pregnancies conceived through fertility treatments (whether ovulation agents, insemination or assisted reproductive technologies) were collected. Maternal serum concentrations of PlGF, sFlt-1, PAPP-A, AFP, and free β-hCG were obtained, and notches and UtA-PI were measured using Doppler ultrasound. Mean Multiple of the Medians (MoM) and frequencies were computed to estimate the mean differences (MD) or risk ratios (RR) comparing fertility treatment to spontaneous pregnancies. RESULTS 427 (9%) pregnancies out of 4815 were conceived through fertility treatments, using ovulation agents (n = 233, 5%), insemination (n = 174, 4%) and/or assisted reproductive technologies (n = 85, 2%). The latter were associated with significantly lower log10PAPP-A MoM (adjusted MD: -0.02, 95%CI: -0.04 to -0.01), lower log10PlGF MoM (adjusted MD: -0.04, 95%CI: -0.06 to -0.01) and higher log10free β-hCG MoM (adjusted MD: 0.05, 95%CI: 0.01 to 0.09) compared to spontaneous pregnancies. Ovulation agents and insemination were associated with the presence of notches (adjusted RR: 1.24, 95%CI: 1.14 to 1.35; and 1.27, 95%CI: 1.15 to 1.42, respectively) and higher log10UtA-PI MoM (adjusted MD: 0.16, 95%CI: 0.08 to 0.24; and 0.17, 95%CI: 0.07 to 0.27, respectively) than spontaneous pregnancies. CONCLUSION Fertility treatments are associated with significant variations in markers of placentation.
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Affiliation(s)
- Alexandra Côté
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada
| | - Sarah Maheux-Lacroix
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada; Department of Gynecology, Obstetrics and Reproduction, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Yasser Sabr
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, V6H 2N9, Canada; Department of Obstetrics & Gynaecology, College of Medicine, King Saud University, Riyadh, 11633, Saudi Arabia
| | - Cédric Gasse
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada; Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Emmanuel Bujold
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada; Department of Gynecology, Obstetrics and Reproduction, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Amélie Boutin
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada; Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, V6H 2N9, Canada.
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Kelley AS, Badon SE, Lanham MSM, Fisseha S, Moravek MB. Body mass index restrictions in fertility treatment: a national survey of OB/GYN subspecialists. J Assist Reprod Genet 2019; 36:1117-1125. [PMID: 30963351 DOI: 10.1007/s10815-019-01448-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To explore the attitudes of reproductive endocrinology and infertility (REI) and maternal-fetal medicine (MFM) subspecialists regarding the necessity and appropriateness of body mass index (BMI) cutoffs for women seeking fertility treatment. METHODS Members of the Society for Reproductive Endocrinology and Infertility (SREI) and the Society for Maternal Fetal Medicine (SMFM) were invited to participate in a survey querying their knowledge of existing institutional or clinic BMI policies and personal opinions regarding upper and lower BMI cutoffs for a range of fertility treatments, including oral ovulation agents, gonadotropins, and in vitro fertilization. RESULTS Respondents included 398 MFMs and 201 REIs. The majority of REI and MFM providers agreed with upper limit BMI cutoffs (72.5% vs 68.2%, p = 0.29), but REIs were twice as likely to support lower limit BMI restrictions compared to MFMs (56.2% vs 28.4%, p < 0.0001). Those who supported upper BMI restrictions were more likely to be female and report existing institutional BMI cutoffs. The majority of respondents (99.3%) believed that an official statement to guide clinicians should be issued by a national professional organization. CONCLUSIONS Although practice patterns widely vary, the majority of REIs and MFMs believe that there should be a BMI cutoff above which women should not be offered immediate fertility treatment. Furthermore, there is a reported need for a written statement by a national professional organization to guide clinical practice and to ensure that OB/GYN subspecialists are providing consistent, fair, and safe recommendations to infertile women at the extremes of BMI.
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Affiliation(s)
- Angela S Kelley
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48108, USA.
| | - Sylvia E Badon
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S M Lanham
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48108, USA
| | - Senait Fisseha
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48108, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48108, USA
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Shahin MN, Magill ST, Dalle Ore CL, Viner JA, Peters PN, Solomon DA, McDermott MW. Fertility treatment is associated with multiple meningiomas and younger age at diagnosis. J Neurooncol 2019; 143:137-44. [PMID: 30868355 DOI: 10.1007/s11060-019-03147-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/07/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Meningiomas are more common in females and 70-80% express the progesterone receptor, raising the possibility that high-dose exogenous estrogen/progesterone exposure, such as occurs during fertility treatments, may increase the risk of developing a meningioma. The goal of this study was to report the incidence of prior fertility treatment in a consecutive series of female meningioma patients. METHODS A retrospective review (2015-2018) was performed of female patients with meningioma, and those with prior fertility treatment were compared to those without fertility treatment using standard statistical methods. RESULTS Of 206 female patients with meningioma, 26 (12.6%) had a history of fertility treatments. Patients underwent various forms of assisted reproductive technology including: in vitro fertilization (50.0%), clomiphene with or without intrauterine insemination (34.6%), and unspecified (19.2%). Median follow up was 1.8 years. Tumors were WHO grade I (78.6%) or grade II (21.4%). Patients who underwent fertility treatments presented at significantly younger mean age compared to those who had not (51.8 vs. 57.3 years, p = 0.0135, 2-tailed T-test), and on multivariate analysis were more likely to have multiple meningiomas (OR 4.97, 95% CI 1.4-18.1, p = 0.0154) and convexity/falx meningiomas (OR 4.45, 95% CI 1.7-11.5, p = 0.0021). CONCLUSIONS Patients in this cohort with a history of fertility treatment were more likely to present at a younger age and have multiple and convexity/falx meningiomas, emphasizing the importance of taking estrogen/progesterone exposure history when evaluating patients with meningioma. Future clinical studies at other centers in larger populations and laboratory investigations are needed to determine the role of fertility treatment in meningioma development.
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Findeklee S, Sklavounos P, Stotz L, Sima RM, Iordache I, Spüntrup C, Kasoha M, Thangarajah F, Solomayer EF, Radosa JC. Influence of androgen levels on conception probability in patients undergoing fertility treatment: a retrospective cohort study. Arch Gynecol Obstet 2019; 299:1481-5. [PMID: 30737584 DOI: 10.1007/s00404-019-05079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/02/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Primary and secondary sterility have become an issue of increasing importance due to demographic and social changes in society. Data regarding the association between female androgen levels and the probability of successful conception after fertility treatment are sparse and contradictive. This study was designed to assess this clinical question. METHODS In this retrospective single-center cohort study concentrations of androgens androstenedione, dehydroepiandrosteronsulfat (DHEAS) and testosterone (ng/ml) were investigated in the serum of patients presenting for sterility at the department of reproductive medicine of Saarland University hospital Homburg between January 2015 and December 2017. Androgen levels were correlated with reproductive outcomes. Statistical analysis was performed with the aid of SPSS version 24. Significance for conception rates in dependence of androgen concentration was assessed using Kruskal-Wallis test (significance was estimated with p < 0.05). RESULTS The laboratory values of a total of 301 patients were examined (64% primary, 36% secondary sterility). Median age at first visit at the fertility department was 32.7 years (range 20-47 years). 64 pregnancies were observed during the study period (conception rate 21.3%). 23 out of 301 patients (7.6%) suffered from hypoandrogenaemia, 248 (82.4%) had normal androgen levels and 30 (10%) showed hyperandrogenaemia (p = 0.25). Regarding patients in whom fertility treatment was successful 3 (4.7%) showed hypoandrogenaemia, 54 (84.4%) were normoandrogenaemic and 7 (10.9%) had hyperandrogenaemia (p = 0.40 Kruskal-Wallis test). CONCLUSIONS We found no association between female androgen levels and sterility and reproductive outcomes.
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Bay B, Boie S, Kesmodel US. Risk of stillbirth in low-risk singleton term pregnancies following fertility treatment: a national cohort study. BJOG 2018; 126:253-260. [PMID: 30341984 DOI: 10.1111/1471-0528.15509] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the risk of stillbirth in low-risk in vitro fertilisation (IVF) pregnancies. DESIGN Register-based national cohort study. SETTING Denmark 2003-2013. POPULATION Cohort of 425 732 singleton pregnancies including 10 235 conceived following IVF/intracytoplasmic sperm injection (ICSI), 4521 conceived following intrauterine insemination (IUI), and 410 976 spontaneously conceived. METHODS Information on pregnancy, obstetrical risk factors, stillbirth, and fertility treatment was obtained from the Danish national health registers for all pregnancies after gestational week 21+6 . We estimated the overall and gestational age-specific risk of stillbirth in low-risk term pregnancies following IVF, ICSI, and IUI. Further, we estimated the association between stillbirth and IVF and ICSI respectively as well as fresh or frozen-thawed embryo transfer. MAIN OUTCOME MEASURES Risk of stillbirth. RESULTS The number of stillbirths in spontaneously conceived and IVF/ICSI low-risk term pregnancies was 525 (0.1%) and 35 (0.3%), respectively. In multivariate analysis, the risk of stillbirth in pregnancies following IVF/ICSI was increased (odds ratio 2.1, 95% CI 1.4-3.1). The risk of stillbirth was correspondingly increased in time-to-event analyses taking risk time for each fetus into account from gestational week 37 and onwards (hazard ratio 2.4, 95% CI 1.6-3.6). In sub-analyses, the risk of stillbirth was increased for pregnancies following ICSI (odds ratio 2.2, 95% CI 1.2-3.1), but not IVF (odds ratio 1.7, 95% CI 0.9-3.1). CONCLUSION We found a systematically increased risk of stillbirth in low-risk term pregnancies following IVF/ICSI. Whether the risk was related to the treatment or to underlying subfertility is uncertain. The results may indicate a need for obstetrical surveillance for these pregnancies when reaching term. TWEETABLE ABSTRACT Increased risk of stillbirth in low-risk term pregnancies following fresh cycle IVF/ICSI.
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Affiliation(s)
- B Bay
- The Fertility Clinic, Department of Gynaecology and Obstetrics, Regional Hospital Horsens, Horsens, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - S Boie
- Department of Gynaecology and Obstetrics, Regional Hospital Randers, Randers, Denmark
| | - U S Kesmodel
- The Fertility Clinic, Herlev and Gentofte Hospital, Hellerup, Denmark
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Kitano Y, Hashimoto S, Matsumoto H, Yamochi T, Yamanaka M, Nakaoka Y, Fukuda A, Inoue M, Ikeda T, Morimoto Y. Oral administration of l-carnitine improves the clinical outcome of fertility in patients with IVF treatment. Gynecol Endocrinol 2018; 34:684-688. [PMID: 29378447 DOI: 10.1080/09513590.2018.1431769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Age-dependent decline of mitochondrial function has been proposed to be a main cause of decline of embryo quality. Then, l-carnitine plays important roles in reducing the membranous toxicity of free-fatty acids by forming acyl-carnitine and promoting β-oxidation, preventing cell damage. Recent research revealed that l-carnitine played important roles in vitro in oocyte growth, oocyte maturation and embryo development. However, such beneficial effects of l-carnitine in vivo have yet to be verified. The effect of oral l-carnitine supplementation on embryo quality and implantation potential was examined. A total of 214 patients were included in this study. They all previously received in vitro fertilization-embryo transfer (IVF-ET) and failed to conceive. Then they were administered l-carnitine for 82 days on average and underwent IVF-ET again. There were no significant differences in the total number of retrieved oocytes, and their maturation and fertilization rates between before and after l-carnitine administration. The quality of embryos on Days 3 and 5 after insemination was improved following l-carnitine administration (p < .05) in cycles after l-carnitine administration compared with previous cycles. Healthy neonates were born after IVF-ET following l-carnitine administration. Our data suggested that oral administration of l-carnitine to fertility patients improved the developmental competence of their oocytes after insemination.
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Affiliation(s)
- Yuko Kitano
- a IVF Namba Clinic , Osaka , Japan
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | | | | | | | | | | | | | | | - Tomoaki Ikeda
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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Tomassetti C, D'Hooghe T. Endometriosis and infertility: Insights into the causal link and management strategies. Best Pract Res Clin Obstet Gynaecol. 2018;51:25-33. [PMID: 30245115 DOI: 10.1016/j.bpobgyn.2018.06.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/07/2018] [Indexed: 01/01/2023]
Abstract
When evaluating the correlation between endometriosis and infertility with application of the evidence-based guidelines to establish causality in medicine, it becomes apparent that endometriosis causes infertility. This is supported by a strong and consistent association between the two in various settings (prevalence, natural conception, intrauterine insemination (IUI), and assisted reproductive technologies (ARTs)), evidence for a temporal relation, arguments for a dose-response gradient, and proven effects of the removal of lesions on infertility. Next to surgical treatment of endometriosis lesions, medically assisted reproduction treatments such as IUI and ART such as in vitro fertilization are cornerstones of the management of endometriosis-related infertility. Because the revised American Society for Reproductive Medicine (rASRM) staging system is poorly correlated with pregnancy rates as opposed to the Endometriosis Fertility Index (EFI), the latter should be used as the preferred clinical tool to counsel patients on their postoperative fertility management options.
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Tsuda H, Kotani T, Nakano T, Imai K, Ushida T, Hirakawa A, Kinoshita F, Takahashi Y, Iwagaki S, Kikkawa F. The impact of fertility treatment on the neonatal respiratory outcomes and amniotic lamellar body counts in twin pregnancies. Clin Chim Acta 2018; 484:192-6. [PMID: 29860037 DOI: 10.1016/j.cca.2018.05.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND To elucidate the impact of fertility treatment on neonatal respiratory outcomes and amniotic lamellar body counts (LBCs) in twin pregnancies. METHODS One hundred ninety twin pairs, including 99 dichorionic twin (DCT) and 91 monochorionic twin (MCT) pairs were registered at our institutions. All amniotic fluid samples were obtained from each sac at cesarean section. Samples were analyzed immediately after arrival at the laboratory without centrifugation. We divided the patients into 3 groups: the no therapy group (natural conception), the induced ovulation group (with or without intrauterine insemination), and the assisted reproductive technology (ART) group (in vitro fertilization or intracytoplasmic sperm injection). RESULTS No statistically significant associations between the fertility treatment and the rates of neonatal RDS/TTN were observed in the whole study population (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.45-2.00), DCT (OR, 0.86; 95%CI, 0.30-2.47), and MCT (OR, 1.45; 95%CI, 0.41-5.11). In addition, there was no association between the fertility treatment and neonatal RDS/TTN in the propensity score analysis of the whole study population (OR, 1.25; 95%CI, 0.57-2.74). CONCLUSIONS None of the individual types of fertility treatment had a direct impact on respiratory disorders such as RDS and TTN in twin infants.
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Sundheimer LW, Chan JL, Buttle R, DiPentino R, Muramoto O, Castellano K, Wang ET, Williams J, Pisarska MD. Mode of conception does not affect fetal or placental growth parameters or ratios in early gestation or at delivery. J Assist Reprod Genet 2018; 35:1039-1046. [PMID: 29633147 DOI: 10.1007/s10815-018-1176-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/29/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Ratio of fetal weight to placenta size varies by mode of conception (fertility treatments utilized) in animals. Our objective was to assess whether fertility treatments also affect these ratios in humans. METHODS In this retrospective study, we assessed two cohorts: (a) early gestation cohort, women with singleton pregnancies who underwent first trimester vaginal ultrasound and (b) delivered cohort, women who delivered a live-born, singleton infant with placenta disposition to pathology. Crown rump length (CRL) and estimated placental volume (EPV) were calculated from first trimester ultrasound images using a validated computation. Infant birth weight (BW), pregnancy data, placental weight (PW), and placental histopathology were collected. Fetal growth-to-placental weight ratios (CRL/EPV; BW/PW) and placentas were compared by mode of conception. Linear regression was used to adjust for confounding variables. RESULTS Two thousand one hundred seventy patients were included in the early gestation cohort and 1443 in the delivered cohort. Of the early gestation cohort (a), 85.4% were spontaneous conceptions, 5.9% Non-IVF Fertility (NIFT), and 8.7% IVF. In the delivered cohort (b), 92.4% were spontaneous, 2.1% NIFT, and 80 5.5% IVF. There were no significant differences between fetal growth-to-placental weight parameters, ratios, and neonatal birth measurements based on mode of conception. Placenta accreta was significantly higher in the patients receiving fertility treatments (1.2 versus 3.6%, p < 0.05). CONCLUSIONS Mode of conception does not appear to influence fetal growth-to-placental weight ratios throughout gestation. In addition, findings in animal models may not always translate into human studies of infertility treatment outcomes.
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Affiliation(s)
- Lauren W Sundheimer
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine, University of California, 8635 West Third Street, Suite 160W, Los Angeles, CA, 90048, USA
| | - Jessica L Chan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Rae Buttle
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Rosemarie DiPentino
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Olivia Muramoto
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Kerlly Castellano
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Erica T Wang
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine, University of California, 8635 West Third Street, Suite 160W, Los Angeles, CA, 90048, USA
| | - John Williams
- David Geffen School of Medicine, University of California, 8635 West Third Street, Suite 160W, Los Angeles, CA, 90048, USA.,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. .,David Geffen School of Medicine, University of California, 8635 West Third Street, Suite 160W, Los Angeles, CA, 90048, USA.
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Kushnir VA, Seifer DB, Barad DH, Sen A, Gleicher N. Potential therapeutic applications of human anti-Müllerian hormone (AMH) analogues in reproductive medicine. J Assist Reprod Genet 2017; 34:1105-1113. [PMID: 28643088 PMCID: PMC5581791 DOI: 10.1007/s10815-017-0977-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 05/02/2017] [Accepted: 06/07/2017] [Indexed: 11/25/2022] Open
Abstract
Members of the transforming growth factor-beta (TGF-beta) superfamily are key regulators of various physiological processes. Anti-Müllerian hormone (AMH) which is also commonly known as Müllerian-inhibiting substance (MIS) is a member of the TGF-beta superfamily and an important regulator of reproductive organ differentiation and ovarian follicular development. While AMH has been used for diagnostic purposes as a biomarker for over 15 years, new potential therapeutic applications of recombinant human AMH analogues are now emerging as pharmacologic agents in reproductive medicine. Therapeutic uses of AMH in gonadal tissue may provide a unique opportunity to address a broad range of reproductive themes, like contraception, ovulation induction, onset of menopause, and fertility preservation, as well as specific disease conditions, such as polycystic ovarian syndrome (PCOS) and cancers of the reproductive tract. This review explores the most promising therapeutic applications for a novel class of drugs known as AMH analogues with agonist and antagonist functions.
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Affiliation(s)
- Vitaly A Kushnir
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - David B Seifer
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - David H Barad
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, USA
| | - Aritro Sen
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Division of Endocrinology & Metabolism, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, USA
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, Vienna, Austria
- The Rockefeller University, New York, NY, USA
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Reigstad MM, Oldereid NB, Omland AK, Storeng R. Literature review on cancer risk in children born after fertility treatment suggests increased risk of haematological cancers. Acta Paediatr 2017; 106:698-709. [PMID: 28128867 DOI: 10.1111/apa.13755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/21/2016] [Accepted: 01/23/2017] [Indexed: 12/28/2022]
Abstract
Medically assisted fertility treatment, including assisted reproductive technology (ART), is increasingly being used and the subsequent child health outcomes are of interest. Some studies have suggested an elevated risk of somatic morbidity, while others have reported an elevated cancer risk. This review summarises the literature on fertility treatments and childhood cancer, based on 23 cohort and case-control studies. CONCLUSION The findings varied, but reassuring results on overall childhood cancer and fertility treatment were observed. However, some studies suggested an elevated risk of haematological cancers. More large population-based studies are needed, and the growing population of ART children should be monitored.
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Affiliation(s)
- Marte M. Reigstad
- Norwegian National Advisory Unit on Women's Health; Oslo University Hospital; Rikshospitalet HF; Oslo Norway
| | - Nan B. Oldereid
- Section for Reproductive Medicine; Division of Gynecology and Obstetrics; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Anne K. Omland
- Section for Reproductive Medicine; Division of Gynecology and Obstetrics; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Ritsa Storeng
- Norwegian National Advisory Unit on Women's Health; Oslo University Hospital; Rikshospitalet HF; Oslo Norway
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Abstract
Objective To describe associated perinatal behaviors among women using fertility treatment. Methods Data were obtained for 12,197 Maryland women who delivered live neonates from 2004 to 2011 and completed the Pregnancy Risk Assessment Monitoring System survey postpartum. We conducted weighted descriptive and multivariable analyses. Results Among 1368 women using fertility treatments, 28.4 % did not take folic acid daily 1 month before pregnancy, 58.1 % consumed alcohol, 16.0 % were binge drinking, and 7.5 % smoked 3 months before pregnancy, and 12.9 % consumed alcohol and 3.7 % smoked during pregnancy. Additionally, among those who consumed alcohol and smoked before pregnancy, 36.0 % and 25.7 %, respectively, reported not receiving prenatal counseling about alcohol use and smoking. Lack of counseling for these women was higher than for women with unintended pregnancies who consumed alcohol (36.0 % vs. 26.3 %, P < .001) or smoked (25.7 % vs. 15.0 %, P < .001). Women using fertility treatments were less likely to have inadequate folic acid intake [adjusted odds ratio (aOR) 0.14, 95 % confidence interval (CI) 0.10-0.18), consume alcohol (aOR 0.52, 95 % CI 0.40-0.69), and smoke (aOR 0.35, 95 % CI 0.21-0.59) before pregnancy, and no statistically significant differences were found during pregnancy for alcohol consumption (aOR 0.89, 95 % CI 0.59-1.33) or smoking (aOR 0.64, 95 % CI 0.28-1.45) compared to women with unintended pregnancies. Conclusion A significant proportion of women using fertility treatments were not practicing recommended perinatal behaviors or receiving prenatal counseling on preventable risk factors. Ongoing counseling before and during pregnancy may be especially effective for optimizing healthy behaviors among these motivated women undergoing often stressful treatments for fertility.
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Affiliation(s)
- Holly Vo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,University of California, San Diego School of Medicine, 9500 Gilman Drive MC 0606, La Jolla, CA, 92093, USA.
| | - Diana Cheng
- Maternal and Child Health Bureau, Maryland Department of Health and Mental Hygiene, 201 W. Preston Street, Room 313, Baltimore, MD, 21201, USA
| | - Tina L Cheng
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street #8941, Baltimore, MD, 21287, USA
| | - Kamila B Mistry
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Agency for Healthcare Research and Quality, Office of Extramural Research, Education and Priority Populations, 5600 Fishers Lane, Room 06N03, Rockville, MD, 20857, USA
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Bay B, Mortensen EL, Golombok S, Hohwü L, Obel C, Henriksen TB, Kesmodel US. Long-awaited pregnancy: intelligence and academic performance in offspring of infertile parents-a cohort study. Fertil Steril 2016; 106:1033-1040.e1. [PMID: 27379706 DOI: 10.1016/j.fertnstert.2016.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study whether fertility treatment, subfertility, or pregnancy planning are related to long-term intellectual development. DESIGN Cohort study. SETTING Not applicable. PATIENT(S) A total of 5,032 singletons born from 1990 to 1992 in the Aarhus Birth Cohort were followed up to a mean age of 19 years. These children were born as a result of fertility treatment (n = 210), had subfertile parents who took more than 12 months before conceiving naturally (n = 334), had fertile parents who conceived naturally within 12 months (n = 2,661), or had parents who reported the pregnancy as unplanned (n = 1,827). INTERVENTION(S) The children were followed up using questionnaires and information from Danish national registers. MAIN OUTCOME MEASURE(S) Parent reported school difficulties at ages 9-11 years, register-based school grades at ages 16, 17, and 19 years, and conscription intelligence test scores at age 19 years. RESULT(S) We found no evidence of school difficulties in childhood, impaired school performance in adolescence, or lower intelligence in young adulthood in multivariate analyses adjusted for parental age, educational level, maternal parity, before pregnancy body mass index (BMI), smoking and alcohol intake in pregnancy, cohabitation status, child gender, and age. CONCLUSION(S) In the longest follow-up of cognitive development of children conceived after fertility treatment or by subfertile parents conducted so far, this study did not show any association between pregnancy planning, subfertility, or fertility treatment and cognitive ability or academic performance.
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Pasch LA, Holley SR, Bleil ME, Shehab D, Katz PP, Adler NE. Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services? Fertil Steril 2016; 106:209-215.e2. [PMID: 27018159 DOI: 10.1016/j.fertnstert.2016.03.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [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: 11/19/2015] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the extent to which fertility patients and partners received mental health services (MHS) and were provided with information about MHS by their fertility clinics, and whether the use of MHS, or the provision of information about MHS by fertility clinics, was targeted to the most distressed individuals. DESIGN Prospective longitudinal cohort study. SETTING Five fertility practices. PATIENT(S) A total of 352 women and 274 men seeking treatment for infertility. INTERVENTION(S) No interventions administered. MAIN OUTCOME MEASURE(S) Depression, anxiety, and MHS information provision and use. RESULT(S) We found that 56.5% of women and 32.1% of men scored in the clinical range for depressive symptomatology at one or more assessments and that 75.9% of women and 60.6% of men scored in the clinical range for anxiety symptomatology at one or more assessments. Depression and anxiety were higher for women and men who remained infertile compared with those who were successful. Overall, 21% of women and 11.3% of men reported that they had received MHS, and 26.7% of women and 24.1% of men reported that a fertility clinic made information available to them about MHS. Women and men who reported significant depressive or anxiety symptoms, even those with prolonged symptoms, were no more likely than other patients to have received information about MHS. CONCLUSION(S) Psychological distress is common during fertility treatment, but most patients and partners do not receive and are not referred for MHS. Furthermore, MHS use and referral is not targeted to those at high risk for serious psychological distress. More attention needs to be given to the mental health needs of our patients and their partners.
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Affiliation(s)
- Lauri A Pasch
- Department of Psychiatry, University of California, San Francisco, California.
| | - Sarah R Holley
- Department of Psychology, San Francisco State University, San Francisco, California
| | - Maria E Bleil
- Department of Family and Child Nursing, University of Washington, Seattle, Washington
| | | | - Patricia P Katz
- Department of Medicine, University of California, San Francisco, California
| | - Nancy E Adler
- Department of Psychiatry, University of California, San Francisco, California
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Alnot-Burette J, Nakib I, Lipere A, Delemer B, Graesslin O. [Thyroid function for infertile women during ovarian hyperstimulation as part of IVF]. ACTA ACUST UNITED AC 2016; 44:156-62. [PMID: 26966034 DOI: 10.1016/j.gyobfe.2016.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Optimal thyroid function is necessary for an effective fertility. Many authors have suggested that thyroid function has an impact on IVF outcome. Conversely, IVF has been suggested to induce changes in thyroid function. The aim of this study was to determine the nature and the timing of alterations in thyroid function, throughout controlled ovarian hyperstimulation, from the beginning of therapy to the day of triggering ovulation. And make a clarification of the current recommendations of the thyroid function during hormonal stimulation. METHODS Subjects were recruited from March 2013 to July 2013 at the Hospital of the University of Reims. The studied population consisted of 50 infertile patients who had undergone IVF/ICSI cycles. Thyroid axis exploration was realized before therapy and at every hormonal dosage during ovarian monitorage. RESULTS Prematuary fluctuations were observed without impact on pregnancy rate. We could detect potential hypothyroid women thanks to this dosage and define a connection between pregnancy rate and TSH with a threshold closer to 1mUI/L than 2,5mUI/L defined by the endocrine society. CONCLUSIONS The link between thyroid function, forecast of conception and pregnancy is well documented. Currently, there is no recommendation on the rate of TSH targets for the patients in medical assisted procreation.
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Affiliation(s)
- J Alnot-Burette
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - I Nakib
- Service de biologie de la reproduction-CECOS, centre hospitalo-universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - A Lipere
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - B Delemer
- Service endocrinologie, centre hospitalo-universitaire de Reims, rue du Général-Koenig, 51092 Reims cedex, France
| | - O Graesslin
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Abstract
OBJECTIVE To investigate whether twin pregnancy increases the risk for long-term maternal cardiovascular disease (CVD). STUDY DESIGN A retrospective population-based cohort study compared the incidence of long-term CVD in a cohort of women with and without a previous twin delivery. SETTING Deliveries occurred between the years 1988 and 2012. PATIENTS Patients who had a twin birth between years 1988 and 2012 were included in the study, patient that had a singleton delivery included in the control group. MAIN OUTCOME MEASURES CVD was divided into four categories according to severity and type. Kaplan-Meier survival curve was used to estimate cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for CVD. RESULTS During the study period, there were 100 387 women that met the inclusion criteria, 4.6% (n = 4647) delivered twins at least once during the period. The incidence of CVD was 1% in women who had a twin delivery and 1.12% in women who had a singleton delivery. There was no difference in the cumulative incidence of cardiovascular hospitalizations among women who had twin deliveries as compared with singletons. When performing a Cox proportional hazard model, a history of twin delivery did not increase the risk for long-term maternal cardiovascular hospitalizations (adjusted HR = 1.0, 95% CI = 0.8-1.1, p = 0.698). CONCLUSIONS Twin pregnancy is not associated with an increased risk for long-term maternal CVD.
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Affiliation(s)
- Rania Okby
- a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and
| | - Ilana Shoham-Vardi
- b Department of Public Health , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Ruslan Sergienko
- b Department of Public Health , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Eyal Sheiner
- a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and
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Holley SR, Pasch LA, Bleil ME, Gregorich S, Katz PK, Adler NE. Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners. Fertil Steril 2015; 103:1332-9. [PMID: 25796319 DOI: 10.1016/j.fertnstert.2015.02.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/25/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the prevalence and predictors of major depressive disorder (MDD) for women and their partners during the course of fertility treatment. DESIGN Prospective cohort study during an 18-month period. Participants completed interviews and questionnaires at baseline and at 4, 10, and 18 months of follow-up. SETTING Five community and academic fertility practices. PATIENT(S) A total of 174 women and 144 of their male partners who did not have a successful child-related outcome during the time frame of the study. INTERVENTION(S) No interventions administered. MAIN OUTCOME MEASURE(S) The MDD was assessed using the Composite International Diagnostic Interview Major Depression module, a structured diagnostic interview. Additional variables were assessed with self-report questionnaire measures. RESULT(S) Of the women 39.1% and of the men 15.3% met the criteria for MDD during the 18-month course of the study. A binary logistic covariate-adjusted model showed that, for both women and men, past MDD was a significant predictor of MDD during treatment. Past MDD further predicted significant risk for MDD during treatment after controlling for other well-established risk factors (i.e., baseline levels of depression, anxiety, and partner support). CONCLUSION(S) The MDD was highly prevalent for fertility treatment patients and their partners. Past MDD predicted risk for MDD during treatment, and it contributed to MDD risk more than other commonly assessed risk factors. This suggests that patients and their partners would benefit from being routinely assessed for a history of MDD before the start of treatment to best direct psychosocial support and interventions to those most in need.
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Affiliation(s)
- Sarah R Holley
- Department of Psychology, San Francisco State University, San Francisco, California.
| | - Lauri A Pasch
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Maria E Bleil
- Family and Child Nursing, University of Washington, Seattle, Washington
| | - Steven Gregorich
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Patricia K Katz
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Nancy E Adler
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
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Farland LV, Missmer SA, Rich-Edwards J, Chavarro JE, Barbieri RL, Grodstein F. Use of fertility treatment modalities in a large United States cohort of professional women. Fertil Steril 2014; 101:1705-10. [PMID: 24746739 DOI: 10.1016/j.fertnstert.2014.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 12/19/2013] [Revised: 02/21/2014] [Accepted: 03/11/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the use of fertility treatments among a large cohort of women in the United States. DESIGN Cohort study. SETTING Nurses' Health Study II. PATIENT(S) Ten thousand thirty-six women who reported having used fertility treatment on biennial questionnaires from 1993-2009. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Data on patterns of treatment modality were collected via self-report from validated mailed questionnaires. Information on clomiphene, gonadotropin injections alone, and gonadotropin injections as part of intrauterine insemination (IUI) and in vitro fertilization (IVF) was queried. RESULT(S) Most women who reported fertility treatment used clomiphene (94%), with a large majority reporting clomiphene as their only form of treatment (73%). Of women who reported treatment more advanced than clomiphene, 13% had used gonadotropin injections alone, 11% IUI treatment, and 11% IVF. Several subgroups were more likely to use multiple treatment modalities and to initiate treatment with gonadotropins rather than clomiphene, including women living in states with insurance coverage of fertility procedures, with higher household income, younger in age, who remained nulliparous at the study close, and treated after 2000. CONCLUSION(S) Results should be interpreted cautiously, but to our knowledge, this represents the first study of fertility treatment patterns in the United States and could inform public health planning.
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MESH Headings
- Adult
- Age Factors
- Clomiphene/therapeutic use
- Combined Modality Therapy
- Drug Utilization Review
- Female
- Fertility
- Fertility Agents, Female/economics
- Fertility Agents, Female/therapeutic use
- Fertilization in Vitro/statistics & numerical data
- Financing, Personal
- Gonadotropins/therapeutic use
- Health Care Surveys
- Humans
- Income
- Infertility, Female/diagnosis
- Infertility, Female/economics
- Infertility, Female/physiopathology
- Infertility, Female/therapy
- Insemination, Artificial/statistics & numerical data
- Insurance Coverage
- Nurses/economics
- Nurses/statistics & numerical data
- Parity
- Pregnancy
- Reproductive Techniques, Assisted/economics
- Reproductive Techniques, Assisted/statistics & numerical data
- Surveys and Questionnaires
- United States
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
| | - Stacey A Missmer
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Janet Rich-Edwards
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Robert L Barbieri
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francine Grodstein
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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DeLuca LM, Fox NS, Green RS, Stroustrup A, Harris M, Holzman IR, Gibbs K. Ovulation induction and small for gestational age neonates in twin pregnancies. J Neonatal Perinatal Med 2013; 6:217-224. [PMID: 24246593 DOI: 10.3233/npm-1370613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare the incidence of small for gestation age (SGA) neonates in twin gestations conceived by ovulation induction or in vitro fertilization with that of twins conceived spontaneously. STUDY DESIGN A retrospective cohort study was conducted. Subjects were delivered by a single obstetric practice between 2005 and 2011 at the Mount Sinai Medical Center. Maternal and neonatal data were recorded. Our primary outcome was the incidence of SGA, defined as birth weight <10th percentile, from the three modes of conception. Chi square, ANOVA, Fisher's exact test, the Kruskal-Wallis test, the Mantel-Haenszel test, and logistic regression were used in the analysis. RESULTS In unadjusted analysis, using the records of 756 infants from 378 mothers of twin pregnancies, twins conceived by ovulation induction had an increased incidence of SGA (28.1%) compared to those conceived spontaneously (17.1%) and by in vitro fertilization (16.5%, p = 0.006). In a logistic regression model accounting for correlated responses between twins and adjusting for gestational age, gender, chorionicity, and maternal age, the odds ratio (95% confidence interval [CI]) of SGA for the ovulation induction group compared to the spontaneous conception group was 2.64 (1.38-5.05, p = 0.003). The odds ratio (95% CI) of SGA for the in vitro fertilization group compared to the spontaneous conception group was 1.51 (0.88-2.61, p = 0.135). CONCLUSIONS When adjusted for gestational age, gender, chorionicity, and maternal age, twin neonates conceived by ovulation induction, but not those conceived by in vitro fertilization, had increased odds of SGA compared to those conceived spontaneously.
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Affiliation(s)
- L M DeLuca
- Division of Newborn Medicine, Department of Pediatrics, Englewood Hospital and Medical Center, An Affiliate of the Icahn School of Medicine at Mount Sinai, New York, NY, USA
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