Current Opinion in Obstetrics & Gynecology最新文献_第10页

Double stimulation for the management of poor-prognosis patients: where are we going? 双重刺激对不良预后患者的管理:我们将走向何方?

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000869

Pasquale Petrone, Alberto Vaiarelli, Christophe Blockeel

{"title":"Double stimulation for the management of poor-prognosis patients: where are we going?","authors":"Pasquale Petrone, Alberto Vaiarelli, Christophe Blockeel","doi":"10.1097/GCO.0000000000000869","DOIUrl":"https://doi.org/10.1097/GCO.0000000000000869","url":null,"abstract":"Purpose of review: The technical improvements in IVF allowed the implementation of nonconventional ovarian stimulation protocols for some specific patients. Where time is crucial, such as with oncologic patients, poor-prognosis patients, patients with low ovarian reserve, and those with advanced maternal age, access to IVF treatment is even more critical. Some of these protocols might start in the late follicular phase, luteal phase, or involve both stimulations within the same ovarian cycle.Recent findings: Until now, published evidence showed that oocytes retrieved from unconventional protocol seem to be developmentally, genetically, and reproductively competent. Second stimulation in the same ovarian cycle after the conventional approach may represent a sound alternative to oocyte accumulation. This can be proposed in progress after careful counselling focused on the patients' chances of finding at least one euploid embryo on account of their age and of the number of blastocysts obtained after the conventional approach.Summary: The adoption of these new strategies, known as double stimulation protocol, can be conceived as a real full-personalization of ovarian stimulation. Multicentre prospective RCTs are urgently needed to evaluate the efficacy, efficiency, and costs of double stimulation versus two consecutive conventional approaches with standard or mild stimulation and in a different IVF setting.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10197017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Genital tuberculosis, infertility and assisted reproduction. 生殖器结核、不孕症和辅助生殖。

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000866

Nousheen Mir, Lubna Pal

引用次数: 2

Frozen embryo transfers in a natural cycle: how to do it right. 在自然周期中冷冻胚胎移植:如何做得正确。

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000862

Barbara Lawrenz, Laura Melado, Human M Fatemi

{"title":"Frozen embryo transfers in a natural cycle: how to do it right.","authors":"Barbara Lawrenz, Laura Melado, Human M Fatemi","doi":"10.1097/GCO.0000000000000862","DOIUrl":"https://doi.org/10.1097/GCO.0000000000000862","url":null,"abstract":"Purpose of review: Assisted reproductive technology treatment has seen a significant shift from fresh to frozen embryo transfers (FET). Endometrial receptivity in the FET cycle can be achieved through a hormonal replacement cycle or a natural cycle, and the preparation approach has important implications on the pregnancy itself. In the natural cycle approach, planning of the embryo transfer timing might be challenging due to the need to identify ovulation correctly.Recent findings: Ovulation in a natural cycle is characterized by a luteinizing hormone surge, followed by the rise in progesterone (P4) levels, inducing secretory transformation. However, the luteinizing hormone surge can vary widely in its pattern, amplitude and duration and might not even result in the formation of a corpus luteum and P4 production. Monitoring of the luteinizing hormone surge using urinary luteinizing hormone kits might be a convenient approach, however, it is deemed unreliable and should be considered inadequate for securing the best outcome of a FET cycle.Summary: Endometrial receptivity depends on the duration of progesterone exposure to the adequately estrogenized endometrium. In a natural cycle endometrial preparation approach, correct planning for the embryo transfer timing should include the measurement of luteinizing hormone, estradiol and P4.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10573168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

The importance of follicular flushing in optimizing oocyte retrieval. 卵泡冲洗在优化卵母细胞回收中的重要性。

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000870

George Lainas, Tryfon Lainas, Efstratios Kolibianakis

{"title":"The importance of follicular flushing in optimizing oocyte retrieval.","authors":"George Lainas, Tryfon Lainas, Efstratios Kolibianakis","doi":"10.1097/GCO.0000000000000870","DOIUrl":"https://doi.org/10.1097/GCO.0000000000000870","url":null,"abstract":"Purpose of review To critically evaluate the use of follicular flushing during oocyte retrieval. Recent findings The latest meta-analysis evaluating follicular flushing does not favour its use over single aspiration. The randomized controlled trials (RCTs) included, however, are characterized by significant heterogeneity regarding the population analysed, the needle type and lumen used, the aspiration pressure applied and the number of flushing attempts performed. More importantly, information regarding the flow rate used for aspiration is scarce. The only RCT employing a constant flow rate between single aspiration and follicular flushing in women with monofollicular development, suggests that a higher number of oocytes is retrieved after follicular flushing. Summary In order to eliminate clinical heterogeneity that might obscure the detection of the true effect of follicular flushing, randomization to single aspiration and follicular flushing should occur within the same patient. This can be achieved by randomly allocating each patient's ovary to either single aspiration or follicular flushing, maintaining similar flow rates between the groups compared. Given the importance of maximizing the number of oocytes retrieved from a given number of follicles developed, the conduction of properly designed RCTs evaluating follicular flushing is certainly required.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10208668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment options for molecular subtypes of endometrial cancer in 2023. 2023年子宫内膜癌分子亚型的治疗选择。

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000855

Hannah C Karpel, Brian Slomovitz, Robert L Coleman, Bhavana Pothuri

{"title":"Treatment options for molecular subtypes of endometrial cancer in 2023.","authors":"Hannah C Karpel, Brian Slomovitz, Robert L Coleman, Bhavana Pothuri","doi":"10.1097/GCO.0000000000000855","DOIUrl":"https://doi.org/10.1097/GCO.0000000000000855","url":null,"abstract":"Purpose of review: This article reviews treatment strategies in endometrial cancer by molecular subtype.Recent findings: The Cancer Genome Atlas (TCGA) classifies four molecular subtypes of endometrial cancer - mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H), copy number high (CNH)/p53abn, copy number low (CNL)/no specific molecular profile (NSMP), and POLEmut - which are validated and highly prognostic. Treatment consideration by subtype is now recommended. FDA-approved immune checkpoint inhibitors (ICIs) include pembrolizumab and dostarlimab for previously treated dMMR/MSI-H EC, and pembrolizumab/lenvatinib for mismatch repair-proficient/microsatellite-stable endometrial cancer, including CNH/p53abn and CNL/NSMP. ICIs are being studied as first-line therapy in advanced/recurrent endometrial cancer by MMR status, as well as in combination with other targeted agents. Trastuzumab is NCCN compendium listed for HER2-positive serous endometrial cancer, which are primarily p53-abnormal. Antibody-drug conjugates targeting low and high HER2 levels show promise in breast cancer, and are beginning to be studied in endometrial cancer. In addition to hormonal therapy, maintenance therapy with selinexor (XPO1-inhibitor) showed potential benefit in p53 -wildtype endometrial cancer and is being investigated prospectively. Multiple prospective trials are evaluating de-escalation of care for POLEmut endometrial cancer given favorable survival regardless of adjuvant therapy.Summary: Molecular subtyping has important prognostic and therapeutic implications and should be guiding patient management and clinical trial design in endometrial cancer.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10208669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

The future of frozen-thawed embryo transfer in hormone replacement therapy cycles. 激素替代治疗周期中冻融胚胎移植的未来。

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000867

Kristine Løssl, Anne Lærke Spangmose, Louise Laub Asserhøj, Tine Vrist Dam, Anja Pinborg

{"title":"The future of frozen-thawed embryo transfer in hormone replacement therapy cycles.","authors":"Kristine Løssl, Anne Lærke Spangmose, Louise Laub Asserhøj, Tine Vrist Dam, Anja Pinborg","doi":"10.1097/GCO.0000000000000867","DOIUrl":"https://doi.org/10.1097/GCO.0000000000000867","url":null,"abstract":"Purpose of review: This review focuses on the efficacy of letrozole stimulated frozen-thawed embryo transfer (FET) compared to hormone replacement therapy (HRT) FET in women with polycystic ovarian syndrome (PCOS) and/or oligo-anovulation. Further, obstetric and perinatal risks in HRT FET are summarized.Recent findings: The presence of a corpus luteum seems to reduce the risk of pregnancy-related hypertension and preeclampsia after FET. As a natural cycle (NC) FET is not an option for women with oligo-/amenorrhea these women may benefit from FET with mild stimulation compared to HRT FET. The intention of mild stimulation in anovulatory women is to induce (mono) ovulation to mimic the endocrine profiles of the natural cycle and the early pregnancy after natural conception. Mild stimulation by letrozole is patient friendly and cheap compared to gonadotropin stimulated FET and has been increasingly used in recent years. Although the quality of evidence is low, the pregnancy outcomes after letrozole FET seems similar or even better compared to HRT FET in women with PCOS and/or oligo-anovulation.Summary: Natural and modified NC FET should be used whenever possible to mitigate adverse obstetric and perinatal outcomes after HRT FET. For anovulatory women, whenever ovulation can be induced, we advocate the use of mild stimulation FET to create a corpus luteum awaiting results from RCTs limited to oligo-anovulatory women.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9938350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial introductions. 编辑介绍。

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000872

引用次数: 0

The impact of air pollution and endocrine disruptors on reproduction and assisted reproduction. 空气污染和内分泌干扰物对生殖和辅助生殖的影响。

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000868

Denis A Seli, Hugh S Taylor

{"title":"The impact of air pollution and endocrine disruptors on reproduction and assisted reproduction.","authors":"Denis A Seli, Hugh S Taylor","doi":"10.1097/GCO.0000000000000868","DOIUrl":"https://doi.org/10.1097/GCO.0000000000000868","url":null,"abstract":"Purpose of review: Rapid increase in world population accompanied by global industrialization has led to an increase in deployment of natural resources, resulting in growing levels of pollution. Here, we review recent literature on the impact of environmental pollution on human reproductive health and assisted reproduction outcomes, focusing on two of the most common: air pollution and endocrine disruptors.Recent findings: Air pollution has been associated with diminished ovarian reserve, uterine leiomyoma, decreased sperm concentration and motility. Air pollution also correlates with decreased pregnancy rates in patients undergoing infertility treatment using in-vitro fertilization (IVF). Similarly, Bisphenol A (BPA), a well studied endocrine disrupting chemical, with oestrogen-like activity, is associated with diminished ovarian reserve, and abnormal semen parameters, while clinical implications for patients undergoing infertility treatment remain to be established.Summary: There is convincing evidence that environmental pollutants may have a negative impact on human health and reproductive potential. Air pollutions and endocrine disrupting chemicals found in water and food seem to affect male and female reproductive function. Large-scale studies are needed to determine the threshold values for health impact that may drive targeted policies.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10573166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Getting closer to the truth. 越来越接近真相

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000864

Juan A Garcia-Velasco, Emre Seli

引用次数: 0

Embryonic arrest: causes and implications. 胚胎停止:原因和影响。

IF 2.1 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2023-06-01 DOI: 10.1097/GCO.0000000000000871

Gizem N Sahin, Raziye M Yildirim, Emre Seli

{"title":"Embryonic arrest: causes and implications.","authors":"Gizem N Sahin, Raziye M Yildirim, Emre Seli","doi":"10.1097/GCO.0000000000000871","DOIUrl":"https://doi.org/10.1097/GCO.0000000000000871","url":null,"abstract":"Purpose of review: Embryonic arrest is a key determinant of the number of euploid blastocysts obtained after IVF. Here, we review factors that are implicated in the developmental arrest of preimplantation embryos and their relevance for assisted reproduction outcomes.Recent findings: Among the treatment options available to infertile women, IVF is the one associated with most favorable outcomes. The cumulative pregnancy rates in women undergoing IVF are determined by aneuploidy rate (age), ovarian response to stimulation (ovarian reserve), and the rate of embryo developmental arrest. Mutations in maternal effect genes, especially those encoding for subcortical maternal complex, have been implicated in human embryo developmental arrest. In addition, perturbation of biological processes, such as mitochondrial unfolded protein response and long noncoding RNA regulatory pathways, may play a role. However, how each of these factors contributes to embryos' arrest in different cohorts and age groups has not been determined.Summary: Arrest of human embryos during preimplantation development is a common occurrence and is partly responsible for the limited number of euploid blastocysts obtained in assisted reproduction cycles. Although genetic and metabolic causes have been implicated, the mechanisms responsible for human embryo developmental arrest remain poorly characterized.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10203679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0