Fertility and sterility最新文献

{"title":"Fair expectations for patients undergoing preimplantation genetic testing for monogenic disorders: aneuploidy no less of an obstacle.","authors":"Stephanie Willson, Emily Mounts, Marie Werner","doi":"10.1016/j.fertnstert.2024.09.033","DOIUrl":"10.1016/j.fertnstert.2024.09.033","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1008-1009"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic techniques in endometriosis: six steps for excision of rectovaginal nodules - the butterfly method.","authors":"Nicolas Samartzis, Dimitrios Rafail Kalaitzopoulos, Laurin Burla, Mihai Angheluta, Benjamin Merlot, Horace Roman","doi":"10.1016/j.fertnstert.2024.09.022","DOIUrl":"10.1016/j.fertnstert.2024.09.022","url":null,"abstract":"<p><strong>Objective: </strong>To present a standardized and reproducible approach for the surgical excision of deep endometriosis in the rectovaginal septum, represented by #ENZIAN A.</p><p><strong>Design: </strong>Surgical video article.</p><p><strong>Setting: </strong>A tertiary referral center.</p><p><strong>Patient(s): </strong>The case of a patient with an isolated endometriotic nodule in the rectovaginal septum was used to illustrate the surgical technique, also referred to as the butterfly method.</p><p><strong>Intervention(s): </strong>An Intuitive Xi DaVinci system was used at the tertiary referral center, IFEMEndo in Bordeaux, France. Patient consent was obtained.</p><p><strong>Main outcome measure(s): </strong>Step-by-step approach for the excision of endometriosis in the rectovaginal septum.</p><p><strong>Result(s): </strong>This educational film presents a systematic approach dividing the surgical procedure into following six steps: We used the metaphor of the butterfly because it comprehensively and pictorially reflects the resection line of the endometriotic nodule in the rectovaginal septum.</p><p><strong>Conclusion(s): </strong>Surgical management of rectovaginal endometriosis can be challenging and requires as much as possible the preservation of autonomic nerves. A systematic approach enables the endoscopists to perform a safe and complete removal of the lesion.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1157-1159"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expectant management? How to communicate realistic outcomes and the possibility of failure.","authors":"Kiley Hunkler, Eric Widra","doi":"10.1016/j.fertnstert.2024.06.008","DOIUrl":"10.1016/j.fertnstert.2024.06.008","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"991-992"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limiting the number of fresh donor oocytes inseminated with sperm as a strategy to minimize supernumerary embryos.","authors":"Samantha Spring, Shelun Tsai, Zoe Verzani, Steven Spandorfer","doi":"10.1016/j.fertnstert.2024.07.035","DOIUrl":"10.1016/j.fertnstert.2024.07.035","url":null,"abstract":"<p><strong>Objective: </strong>To determine the optimal number of fresh donor oocytes to expose to sperm for patients who want to prioritize reducing surplus embryos while preserving the live birth rate.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>University.</p><p><strong>Patient(s): </strong>Patients who underwent their first in vitro fertilization of fresh donor oocytes at a single academic institution between January 2013 and November 2022. Patients were excluded if they used a directed oocyte donor, donor aged >32 years, gestational carrier, surgically retrieved sperm, or preimplantation genetic testing.</p><p><strong>Intervention(s): </strong>Number of fresh mature donor oocytes fertilized via intracytoplasmic sperm injection.</p><p><strong>Main outcome measure(s): </strong>The primary outcome was the number of cryopreserved supernumerary blastocysts. The number of supernumerary blastocysts was defined as the number of blastocysts remaining after the first live birth, or if the patient did not have a live birth, the number of supernumerary blastocysts was determined by the number of blastocysts remaining after the last transfer cycle. The Kruskal-Wallis rank sum test was used to determine differences in number of supernumerary blastocysts.</p><p><strong>Result(s): </strong>A total of 543 patients who underwent 750 embryo transfer cycles using fresh donor oocytes were included. The average recipient age was 42.9 ± 3.8 years, and the average oocyte donor age was 26.6 ± 3.0 years. For our cohort, patients received a median of 10 (interquartile range [IQR], 8-14) mature donor oocytes; 8 (IQR, 6-11) were injected with sperm, 4 (IQR, 3-6) usable embryos were developed, and 2 (IQR, 0-5) supernumerary blastocysts remained. Patients were then divided into four quartiles on the basis of the number of mature donor oocytes received (≤7, 8-10, 11-14, or ≥15). There was a significant increase in the median number of cryopreserved supernumerary blastocysts as the number of mature donor oocytes exposed to sperm increased (1 vs. 2 vs. 3 vs. 6 blastocysts in the first, second, third, and fourth quartiles, respectively). There were no statistically significant differences in live birth rates between the quartiles.</p><p><strong>Conclusion(s): </strong>The number of supernumerary blastocysts significantly increased as more mature donor oocytes were exposed to sperm. This study can serve as a counseling tool for patients with concerns regarding excess cryopreserved embryos when using fresh donor oocytes.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1048-1054"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To see or not to see? That is the miscarriage management question.","authors":"Salomeh Salari, Steven R Lindheim","doi":"10.1016/j.fertnstert.2024.09.021","DOIUrl":"10.1016/j.fertnstert.2024.09.021","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1022-1023"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative recurrence of ovarian endometrioma and hormone phobia: can physicians successfully overcome patient \"pill fatigue\"?","authors":"Paolo Vercellini, Paola Viganò, Edgardo Somigliana","doi":"10.1016/j.fertnstert.2024.09.050","DOIUrl":"10.1016/j.fertnstert.2024.09.050","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1017-1019"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion.","authors":"","doi":"10.1016/j.fertnstert.2024.09.034","DOIUrl":"10.1016/j.fertnstert.2024.09.034","url":null,"abstract":"<p><p>The Ethics Committee recommends that in vitro fertilization centers develop patient-centered policies regarding requests for futile treatment. In most cases, clear communication can avoid a direct confiict, but clinicians ethically may refuse to provide treatment believed to be futile or to carry a very poor prognosis. In certain instances, clinicians may provide limited treatment, which they judge likely to be futile, but must be vigilant in their presentation of risks, benefits, and alternatives. This version replaces the previously published draft of this name last published in 2019.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1002-1007"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of degradable polymer film in the management of severe or moderate intrauterine adhesions (PREG-2): a randomized, double-blind, multicenter, stratified, superiority trial.","authors":"Hervé Fernandez, Laura Miquel, Jérémy Sroussi, Steven Weyers, Meritxell Munmany, Xiping Luo, Petr Kovar, Yue Wang, Brunella Zizolfi, Anna Surbone, Victoire Delporte, Enrique Moratalla, Marine Sauvan, Gaetano Perrini, Long Sui, Michal Mara","doi":"10.1016/j.fertnstert.2024.07.020","DOIUrl":"10.1016/j.fertnstert.2024.07.020","url":null,"abstract":"<p><strong>Objective: </strong>To study the effectiveness of a new intrauterine degradable polymer film (Womed Leaf) in the management of moderate to severe intrauterine adhesions (IUA).</p><p><strong>Design: </strong>PREG-2 study was a multicenter, double-blind, randomized, controlled, stratified, two-arm superiority clinical trial conducted in 16 centers in seven countries.</p><p><strong>Setting: </strong>Not applicable.</p><p><strong>Patient(s): </strong>Patients ≥18 years scheduled for hysteroscopic adhesiolysis because of symptomatic severe or moderate adhesions (according to American Fertility Society [AFS] IUA score) were considered eligible for the study.</p><p><strong>Intervention(s): </strong>After adhesiolysis, patients were randomized at a 1:1 ratio to either have a Womed Leaf film inserted (intervention group) or not (control group).</p><p><strong>Main outcome measure(s): </strong>The primary effectiveness endpoint of the study was the change in AFS IUA score on second-look hysteroscopy (SLH), assessed by an independent evaluator, and compared with baseline. Information on the rate of no IUA and responder rate was collected as secondary effectiveness outcomes, while reported adverse events and patient-reported outcomes as safety and tolerability measures.</p><p><strong>Result(s): </strong>Between October 26, 2021, and September 28, 2023, a total of 160 women were randomized (Womed Leaf: n = 75 and controls: n = 85). The reduction in IUA AFS score on SLH was significantly higher in the intervention compared with the control group (mean 5.2 ± 2.8 vs. 4.2 ± 3.2). Similarly, the absence of adhesions on SLH was significantly higher in the intervention group (41% vs. 24%; odds ratio, 2.44; confidence interval, 1.161-5.116). None of the reported adverse events were serious or considered related to the device.</p><p><strong>Conclusion(s): </strong>Womed Leaf is effective and safe in the management of symptomatic severe or moderate IUAs.</p><p><strong>Clinical trial registration number: </strong>Clinicaltrials.gov identifier: NCT04963179.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1124-1133"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undisturbed culture: a clinical examination of this culture strategy on embryo in vitro development and clinical outcomes.","authors":"María Ángeles Valera, Akhil Garg, Lorena Bori, Fernando Meseguer, José María de Los Santos, Marcos Meseguer","doi":"10.1016/j.fertnstert.2024.07.018","DOIUrl":"10.1016/j.fertnstert.2024.07.018","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effect of a fully undisturbed culture strategy over a sequential one on embryo in vitro development and clinical outcomes in intracytoplasmic sperm injection (ICSI) cycles.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>University-affiliated private IVF center.</p><p><strong>Patient(s): </strong>This study included 4,564 ICSI cycles performed over 5 years, including autologous and oocyte donation treatments with extended embryo culture until blastocyst in one of the two defined culture strategies.</p><p><strong>Intervention(s): </strong>Embryo cohorts were cultured in one of two culture systems: a fully undisturbed culture, including an incubator with integrated time-lapse technology, a one-step culture medium and embryo selection assisted by semi-automatic tools on the basis of embryo morphokinetics, or a sequential culture, using a conventional benchtop incubator, sequential media and traditional morphological evaluation under optical microscope. The effect of the culture strategies on embryo development and clinical outcomes was quantified by generalized estimated equations, controlling for possible confounders through the inverse probability of the treatment weighting method.</p><p><strong>Main outcome measure(s): </strong>Weighted odds ratios (ORs) and 95% confidence intervals (CIs) for live birth rate after fresh single embryo transfer and the cumulative live birth rate. In addition, blastocyst development and morphology and other intermediate outcomes were also assessed.</p><p><strong>Result(s): </strong>A significant positive association was found between the employment of undisturbed embryo culture and higher live birth rate in the first embryo transfer in both autologous (OR, 1.617; 95% CI, 1.074-2.435) and oocyte donation cycles (OR, 1.316; 95% CI, 1.036-1.672). Cumulative live birth rate after 1-year follow-up was also positively associated with the undisturbed culture strategy in oocyte donation cycles (OR, 1.5; 95% CI, 1.179-1.909), but not in autologous cycles (OR, 1.051; 95% CI, 0.777-1.423). Similarly, blastocyst rate, good morphology blastocyst rate, and utilization rate were positively associated with the employment of undisturbed culture in oocyte donation cycles, but not in autologous cycles.</p><p><strong>Conclusion(s): </strong>These findings imply that a culture system combining integrated time-lapse incubators with a one-step culture medium may enhance the success rates of patients undergoing ICSI treatment by increasing the production of higher quality blastocysts and improving embryo selection while streamlining laboratory procedures and workflow.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1037-1047"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimüllerian hormone levels are associated with time to pregnancy in a cohort study of 3,150 women.","authors":"Scott M Nelson, Martin Shaw, Benjamin J Ewing, Kate McLean, Afton Vechery, Sharon F Briggs","doi":"10.1016/j.fertnstert.2024.06.024","DOIUrl":"10.1016/j.fertnstert.2024.06.024","url":null,"abstract":"<p><strong>Objective: </strong>To study the association between antimüllerian hormone (AMH) levels and time of pregnancy. Although it has been hypothesized that serum AMH levels may indicate the chance of conception, findings have been mixed. Given that any association is expected to be modest, and it is possible that previous studies have been underpowered, we investigated this relationship in the largest prospective cohort to date.</p><p><strong>Design: </strong>Prospective time-to-pregnancy cohort study.</p><p><strong>Setting: </strong>Community.</p><p><strong>Patient(s): </strong>A total of 3,150 US women who had been trying to conceive for <3 months and had purchased a Modern Fertility hormone test.</p><p><strong>Intervention(s): </strong>We developed a discrete time-to-event model using a binomial complementary log-log error structure within a generalized additive modeling framework, adjusting for confounding factors such as age, body mass index, parity, smoking status, polycystic ovary syndrome, and others. Sensitivity analyses were performed in women with regular menstrual cycles (21-35 days), who did not report using fertility treatments, using alternate AMH level categories (<0.7, 0.7-8.5, >8.5 ng/mL), and AMH levels as a continuous measure.</p><p><strong>Main outcome measure(s): </strong>Primary outcomes included cumulative conception probability within 12 cycles and relative fecundability per menstrual cycle. Conception was defined by a self-reported positive pregnancy test.</p><p><strong>Result(s): </strong>Participants contributed 7.21 ± 5.32 cycles, with 1,325 (42.1%) achieving a pregnancy. Women with low AMH levels (<1 ng/mL, n = 427) had a lower chance of natural conception (adjusted hazard ratio [adjHR], 0.77; 95% confidence interval [CI], 0.64-0.94) compared with women with normal AMH levels (1-5.5 ng/mL). There was no difference between high (5.5+ ng/mL) and normal AMH level categories (adjHR, 1.11; 95% CI, 0.94-1.31). The inclusion of AMH improved the model (net reclassification index 0.10 [0.06-0.14]). The instantaneous probability of conception was highest in cycle four across all AMH categories: the probability of natural conception was 11.2% (95% CI, 9.0-14.0) for low AMH levels, 14.3% (95% CI, 12.3-16.5) for normal AMH levels, and 15.7% (95% CI, 12.9-19.0) for high AMH levels. In the regular cycles sensitivity analysis (n = 1,791), the low AMH group had a lower chance of conception (adjHR, 0.77; 95% CI, 0.61-0.97) in the low AMH group compared with normal AMH, and similarly in the continuous model (adjHR, 0.90; 95% CI, 0.85-0.95).</p><p><strong>Conclusion(s): </strong>Low AMH levels (<1 ng/mL) are independently associated with a modest but significant reduction in the chance of conception.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1114-1123"},"PeriodicalIF":6.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}