Seminars in reproductive medicine最新文献

{"title":"Ovarian Hyperstimulation: Diagnosis, Prevention, and Management.","authors":"Paolo Emanuele Levi-Setti,&nbsp;Noemi Di Segni,&nbsp;Clara Gargasole,&nbsp;Camilla Ronchetti,&nbsp;Federico Cirillo","doi":"10.1055/s-0041-1736492","DOIUrl":"https://doi.org/10.1055/s-0041-1736492","url":null,"abstract":"<p><p>Ovarian hyperstimulation syndrome (OHSS) is a severe complication of controlled ovarian stimulation (COS). Pathogenesis of the disease is based on massive transudation of protein-rich fluid from the vascular compartment into the peritoneal, pleural and pericardial spaces, with a variable picture of clinical manifestations depending on its severity. Nowadays OHSS can easily be avoided by several prevention methods, ranging from identification of high-risk patients, choice of a correct protocol stimulation, trigger with gonadotropin-releasing hormone (GnRH) agonists or, finally, the freeze-all strategy. When OHSS occurs, it can usually be managed as outpatient care. Only if severe/critical cases are diagnosed hospitalization is necessary for appropriate rehydration, monitoring of fluid balance and eventual drainage of ascitic fluid. One of the most dangerous complications of OHSS is venous thromboembolism (VTE). Thromboprophylaxis has shown to be cost effective and widely used, while there are controversies regarding the usage of low dose aspirin (LDA) as a preventive measure.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39514176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Lapse Systems: A Comprehensive Analysis on Effectiveness.","authors":"Patricia Fadon,&nbsp;Eleanor Gallegos,&nbsp;Salonika Jalota,&nbsp;Lourdes Muriel,&nbsp;Cesar Diaz-Garcia","doi":"10.1055/s-0041-1742149","DOIUrl":"https://doi.org/10.1055/s-0041-1742149","url":null,"abstract":"<p><p>Time-lapse systems have quickly become a common feature of in vitro fertilization laboratories all over the world. Since being introduced over a decade ago, the alleged benefits of time-lapse technology have continued to grow, from undisturbed culture conditions and round the clock, noninvasive observations to more recent computer-assisted selection of embryos through the development of algorithms. Despite the global uptake of time-lapse technology, its real impact on clinical outcomes is still controversial. This review aims to explore the different features offered by time-lapse technology, discussing incubation, algorithms, artificial intelligence and the regulation of nonessential treatment interventions, while assessing evidence on whether any benefit is offered over conventional technology.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39804761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sperm Selection Technology in ART.","authors":"Catherine Martin,&nbsp;Emma Woodland","doi":"10.1055/s-0041-1732313","DOIUrl":"https://doi.org/10.1055/s-0041-1732313","url":null,"abstract":"<p><p>Intracytoplasmic sperm injection (ICSI) is a commonly used in vitro fertilization technique. Selection of sperm for injection is currently done using subjective assessment of morphology, which may not accurately identify the best-quality sperm. Hyaluronic acid receptors on sperm plasma membranes are a marker of maturity, and sperms which are capable of binding immobilized hyaluronic acid in vitro are of higher quality. This can be used as an advanced sperm selection technique to choose sperm for ICSI, termed physiological ICSI (PICSI). Several studies reported improved fertility treatment outcomes when using PICSI compared with conventional ICSI; however, the majority of studies are underpowered. Recently, a large, multicenter, randomized controlled trial, known as the Hyaluronic Acid Binding Sperm Selection (HABSelect) trial, found a significant reduction in miscarriage rates with PICSI, but no significant effect on live birth rate. There are still many avenues through which PICSI may provide an advantage, subject to confirmation by future research, such as improved long-term health of offspring. Other advanced sperm selection techniques include intracytoplasmic morphologically selected sperm injection, magnetic-activated cell sorting, and Zeta potential sperm selection; however, the most recent Cochrane review concluded that there is currently insufficient evidence to ascertain whether these techniques improve clinical outcomes, such as live birth rates.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39179920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombophilia, Antithrombotic Therapy, and Recurrent Pregnancy Loss: A Call for Pragmatism in the Face of Unknowns.","authors":"Gregory Piazza,&nbsp;Elvira Grandone","doi":"10.1055/s-0041-1735628","DOIUrl":"https://doi.org/10.1055/s-0041-1735628","url":null,"abstract":"A diagnosis of recurrent pregnancy loss (RPL) may represent one of the darkest times for a couple trying to build a family. While aneuploidy and anatomical or functional abnormalities of the reproductive systemmayexplain someRPLs,many patients are left without an explanation for recurrent miscarriages, andmore importantly, without a clear therapeutic strategy for conception and live birth. While many of these couples turn to assisted reproductive therapy (ART), failed cycles, especially after transfer of euploid embryos, often result in further physical, emotional, psychological, and financial hardship. Although epidemiological studies suggest inherited and acquired thrombophilia as a potential risk factor for RPL and failed ART cycles, data have not been consistent, and causality remains unproven.1 Furthermore, implementation of treatment strategies to prevent RPL and failed ART cycles, such as antithrombotic and antiplatelet therapy, has been hindered by lack of high-quality randomized controlled trial (RCT) data.2 The design and execution of adequately powered RCTs have been hampered by several obstacles, including scarcity of funding opportunities and slow enrollment.3 Ultimately, the dilemma facing investigators, clinicians, and patients is whether to wait for definitive RCTs that may be logistically difficult to execute or find new and innovative scientific approaches to illuminate the pathway forward. In the absence of adequate data to drive guideline recommendations, some clinicians may be reluctant to prescribe antithrombotic therapy for patients with RPL who may benefit, while others may be too quick and too broad in advising such treatments, resulting in an unfavorable balance of safety and efficacy. The growth in the number of women with RPL undergoing ART in the United States and Europe has steadily outpaced research focused on the link between miscarriage and thrombophilia and potential therapeutic interventions.4,5 Root causes of this dichotomy include limited advocacy and leadership, scarce research funding, and study enrollment challenges. The social stigma of infertility, lack of public awareness surrounding thrombophilia, and limited clinical recognition of thrombosis as a contributor to RPL undermine advocacy efforts that would increase support for such research. Clinical expertise and scientific investigation focused on thrombophilia and infertility are typically limited to a few centers of excellence in each region or country resulting in a paucity of collaborative research networks necessary to champion RCTs. Funding continues to be a key obstacle to definitive research focused on thrombophilia and infertility, especially since RCTs typically incur the greatest expense. While professional societies such as the American Society for Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE) provide a critical Elvira Grandone, MD, PhD Gregory Piazza, MD, MS","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39600929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sperm DNA Fragmentation.","authors":"Stamatios Karavolos","doi":"10.1055/s-0041-1736261","DOIUrl":"https://doi.org/10.1055/s-0041-1736261","url":null,"abstract":"<p><p>Sperm DNA fragmentation refers to the accumulation of adducts as well as single- or double-strand DNA breaks and reflects the sperm DNA quality. Current data suggest that there are differences in sperm DNA quality among individuals with high or low fertility, and this observation has led to the idea that testing sperm DNA fragmentation could be a useful test of male fertility. However, sperm DNA fragmentation has become one of the most frequently debated topics in reproductive medicine, as there is no agreement about the optimal way to test for DNA fragmentation, the clinically significant level of sperm DNA fragmentation, as well as the best therapeutic options for infertile men. This article presents current evidence related to sperm DNA fragmentation and its role in managing male infertility.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39528658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Androgen Priming in Women with Reduced Ovarian Reserve Undergoing Assisted Reproductive Technology.","authors":"Alison Richardson,&nbsp;Kanna Jayaprakasan","doi":"10.1055/s-0041-1735646","DOIUrl":"https://doi.org/10.1055/s-0041-1735646","url":null,"abstract":"<p><p>Androgen priming with either dehydroepiandrosterone (DHEA) or testosterone has been suggested as an adjunct to improve in vitro fertilization (IVF) outcomes in women with diminished ovarian reserve (DOR). Numerous studies have investigated the effects of both DHEA and testosterone on IVF outcome. The results were inconsistent, and the quality of most studies is substandard. Meta-analyses have consistently reported that DHEA does appear to significantly improve IVF outcome in women with predicted or proven poor ovarian response (POR), but these have included some normal responders and/or nonrandomized studies. Our meta-analyses including randomized controlled trials (RCTs) incorporating only women with DOR or POR suggest that DHEA confers no benefit. While meta-analyses of RCTs on the use of testosterone in women with DOR or POR showed an improved IVF outcome, most studies included are of low quality with high risk of bias. When analysis of data from studies of only low-risk bias was performed, such a benefit with testosterone was not observed. Although recruitment may well be a challenge, a large, well-designed RCT is, however, still warranted to investigate whether or not androgen priming with either DHEA or testosterone should be recommended as an adjuvant treatment for women with DOR or POR undergoing IVF.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39398601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to the Evaluation and Treatment of Venous Thromboembolism in Pregnancy.","authors":"Benjamin Brenner,&nbsp;Elvira Grandone,&nbsp;Alexander Makatsariya,&nbsp;Jamilya Khizroeva,&nbsp;Victoria Bitsadze,&nbsp;Maria Tretyakova","doi":"10.1055/s-0041-1736188","DOIUrl":"https://doi.org/10.1055/s-0041-1736188","url":null,"abstract":"<p><p>Thrombosis in pregnancy is a major cause of maternal and fetal morbidity and mortality. Risk stratification of venous thromboembolism (VTE) during pregnancy is complex. The hypercoagulability observed in pregnant women can reduce bleeding during childbirth, but may cause thrombosis especially in the presence of additional prothrombotic risk factors such as antiphospholipid antibodies or genetic thrombophilic defects. The availability of large datasets allows for the identification of additional independent risk factors, including assisted reproductive technologies (ARTs), endometriosis, and recurrent pregnancy loss. Data on the risk of VTE linked to COVID-19 in pregnant women are very limited, but suggest that infected pregnant women have an increased risk of VTE. Current guidelines on the prevention and treatment of VTE in pregnancy are based on available, albeit limited, data and mainly present expert opinion. Low-molecular-weight heparins (LMWHs) are the mainstay of anticoagulation to be employed during pregnancy. Administration of LMWH for VTE treatment in pregnancy should be based on the personalized approach, taking into account a weight-based adjusted scheme. During gestation, due to physiological changes, in women at high risk of VTE, monitoring of anti-Xa activity is performed to ensure adequate LMWH dosing. As for the treatment duration for pregnant women with acute VTE, guidelines suggest that anticoagulation should be continued for at least 6 weeks postpartum for a minimum total duration of therapy of 3 months.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39469276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometrial Factor in Unexplained Infertility and Recurrent Implantation Failure.","authors":"Xavier Santamaria,&nbsp;Carlos Simón","doi":"10.1055/s-0041-1735199","DOIUrl":"https://doi.org/10.1055/s-0041-1735199","url":null,"abstract":"<p><p>Unexplained infertility (UI) and recurrent implantation failure (RIF) are diagnoses based on failed pregnancy attempts within current infertility treatment models. Both diagnoses are made when fertility is unexplained based on current diagnostic methods and has no clear cause; UI is diagnosed when testing is inconclusive, and RIF is diagnosed after three failed in vitro fertilization cycles. In both cases, interventions are often introduced without an understanding of the cause of the infertility, frequently leading to frustration for patients and caregivers. Here, we review evidence to support an influence of endometrial factor in patients given these poorly defined diagnoses and possible treatments targeting the endometrium to improve outcomes in these patients.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39337588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Baby at All Costs? Exploring the Use and Provision of Unproven Adjuvant Treatments in the Context of IVF.","authors":"Georgina L Jones,&nbsp;Victoria Lang,&nbsp;Nicky Hudson","doi":"10.1055/s-0041-1731789","DOIUrl":"https://doi.org/10.1055/s-0041-1731789","url":null,"abstract":"<p><p>The year 2018 marked 40 years since the birth of Louise Brown, the first baby born as a result of pioneering in vitro fertilization (IVF) treatment. Since then, advances have seen a wide range of reproductive technologies emerge into clinical practice, including adjuvant treatments often referred to as IVF \"add-ons.\" However, these \"optional extras\" have faced growing criticism, especially when they have often come at additional financial cost to the patient and have little evidence supporting their efficacy to improve pregnancy or birth rates. Despite this, according to the latest national patient survey by the Human Fertilisation and Embryology Authority, three quarters of patients who had fertility treatment in the United Kingdom in the past two years had at least one type of treatment add-on highlighting the growing demand for these interventions. This article uses a psychosocial perspective to consider the motivations behind patient and clinician behavior along with the wider societal and economic factors that may be impacting upon the increase in the use of adjuvant treatments in fertility clinics more widely. It suggests the reasons fertility patients use unproven \"optional extras\" are complex, with interpersonal, psychological, and social factors intertwining to generate an increase in the use of IVF add-ons.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39398599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Current Role of Induced Endometrial Trauma (Endometrial Scratch) in Women Undergoing Infertility Treatment.","authors":"Mostafa Metwally,&nbsp;Stephen Walters,&nbsp;Robin Chatters","doi":"10.1055/s-0041-1739162","DOIUrl":"https://doi.org/10.1055/s-0041-1739162","url":null,"abstract":"<p><p>Induced endometrial trauma, otherwise known as endometrial scratch is a simple technique that has been rapidly adopted into clinical practice, mainly for women having IVF treatment, in an attempt to increase pregnancy rates. The introduction of endometrial scratch followed early reports of improved clinical pregnancy rates in women with repetitive implantation failure after having the procedure and follows on from evidence from animal models in the early 20^th century suggesting that mechanical trauma to the endometrium can induce decidual changes. Due to the ease and low cost of the procedure, it has been rapidly adopted as an add-on to fertility treatments, in many cases where evidence is still lacking. Despite the initial publication of a large number of studies that demonstrated encouraging improvements in pregnancy rates in women who underwent this procedure, these studies were mainly limited by the small sample sizes and heterogeneity of their study populations, leading to limited validity of the evidence provided by these studies. More recently, three large randomized controlled studies have been published that paint a different picture regarding the value of this procedure. This article explores the evolution of the evidence and the current state of endometrial scratch as an adjuvant therapy for women undergoing IVF treatment.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39893581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}