F&S reviews最新文献

{"title":"Modifiable socioeconomic and lifestyle risk factors for female infertility in Asia: a systematic review from the population health perspective","authors":"Ling-Jun Li Ph.D. ,&nbsp;Ashley Chow B.Sc. ,&nbsp;Audrey J. Gaskins Ph.D. ,&nbsp;Jie Ning Jovin Lee B.Sc. ,&nbsp;Mahesh Choolani Ph.D. ,&nbsp;Brian K. Kennedy Ph.D. ,&nbsp;Zhongwei Huang Ph.D. ,&nbsp;Yap Seng Chong M.D. ,&nbsp;Cuilin Zhang Ph.D.","doi":"10.1016/j.xfnr.2022.09.001","DOIUrl":"https://doi.org/10.1016/j.xfnr.2022.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>To pinpoint the knowledge gaps and systematically identify modifiable infertility-related socioeconomic and lifestyle risk factors in Asian women, since most studies on female infertility-related risk factors were conducted in the Western populations. This review pinpointed the knowledge gaps and aimed to systematically identify modifiable infertility-related socioeconomic and lifestyle risk factors in Asian women.</p></div><div><h3>Evidence Review</h3><p>We performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews<span> and Meta-Analyses checklist from January 1, 1990, to October 31, 2021, in PubMed, the Web of Science, Embase, and Scopus, using a set of keywords related to our schemes, such as socioeconomics, lifestyle, infertility, and time to pregnancy. We shortlisted a combination of available full texts, English publications, original research articles, human subjects, and nonpregnant women of childbearing age with the intent of conceiving without medical assistance as the population of interest for further screening.</span></p></div><div><h3>Results</h3><p>We included 43 Asian studies that reported modifiable socioeconomic and lifestyle risk factors with the following outcomes: time to pregnancy; pregnancy rate; or infertility rate. Similar to the Western populations, female infertility in Asian women was associated with advanced age at marriage, sexual dysfunction, elevated stress levels, and greater adiposity. Interestingly, a higher socioeconomic status in Asian women was positively associated with female infertility, whereas a higher socioeconomic status in their male partners was inversely associated with couple infertility. Regrettably, few publications reported lifestyle risk factors, such as physical activity, dietary food groups, sleep disorders, and substance use.</p></div><div><h3>Conclusion</h3><p>Asian women may have more infertility-related cultural and dietary diversity, and it is worthy of future research efforts. It is also critical and more effective to tackle the infertility problem in both women and men. Hence, we discussed the imperative need for research efforts in Asian couples.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"4 1","pages":"Pages 78-99"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49906533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of obesity and subsequent weight loss through bariatric surgery on male fertility","authors":"Sally F. Vitez M.D. ,&nbsp;Bestoun H. Ahmed M.D., F.A.C.S. ,&nbsp;Miguel Brieño-Enríquez M.D., Ph.D. ,&nbsp;Kathleen Hwang M.D.","doi":"10.1016/j.xfnr.2022.11.002","DOIUrl":"https://doi.org/10.1016/j.xfnr.2022.11.002","url":null,"abstract":"<div><p><span>This is a comprehensive review evaluating current literature published on the impact of obesity and subsequent weight loss on male factor infertility. The prevalence of obesity is increasing worldwide, and it is projected that by 2030, &gt;50% of all adults in the United States will be obese. Obesity, with excess adipose tissue<span>, leads to a proinflammatory state with higher reactive oxygen species<span> production, dysfunction of the hypothalamic-pituitary-gonadal axis, and subsequent alterations in spermatogenesis. There is growing evidence to support the negative impact of obesity on male </span></span></span>factor fertility<span><span><span>, specifically manifesting as reduced semen parameters. However, the male contribution to fertility goes beyond the standard semen analysis<span>. As a result, in-depth molecular studies through metabolomics<span>, proteomics, and </span></span></span>epigenomics have been described to better understand male factor infertility and the impact of obesity on subfecundity. Given the obesity epidemic, there has been an increase in medically supervised weight loss programs and surgical intervention for weight loss. </span>Bariatric surgery<span><span> has become the mainstay of treatment for obesity. Early case reports documented a harmful impact of bariatric surgery on semen parameters; however, more recent </span>prospective cohort studies identify no change in standard semen parameters after significant weight loss after bariatric surgery. Nonetheless, the clinical impact of bariatric surgery on fertility and ongoing clinical pregnancy when performed for obese male partners remains undetermined and an area for further study.</span></span></p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"4 1","pages":"Pages 38-49"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49906540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometrial receptivity, to test or not to test: the evidence on contemporary assays","authors":"Elizabeth Clain M.D. ,&nbsp;Kate Devine M.D.","doi":"10.1016/j.xfnr.2022.11.001","DOIUrl":"https://doi.org/10.1016/j.xfnr.2022.11.001","url":null,"abstract":"<div><p>Despite improvements in in vitro fertilization success over the last 2 decades, the live birth rates do not exceed 65% even after transfer of a preimplantation genetic testing for aneuploidy<span><span> normal blastocyst<span> to a sonographically optimal endometrium<span>. Consequently, there has been a search for more subtle endometrial factors that may deter sustained implantation and for treatments to mitigate these factors. Assays evaluating the window of implantation, markers of inflammation, normal vs. abnormal </span></span></span>microbiome<span><span>, and variations in the expression of endometrial proteins thought to be associated with implantation are commercially available and sought out by patients. The Endometrial Receptivity Assay aims to individualize embryo transfer timing but lacks sufficient data to support its use. Chronic </span>endometritis may be associated with poor reproductive outcomes in some patients; however, accurate diagnosis is a challenge, and there is no high-quality evidence supporting routine assessment. Assessment of the uterine microbiome, ReceptivaDx, and the endometrial function test similarly do not have sufficient data to recommend routine testing in either the general infertility population or those who have experienced unsuccessful embryo transfer. Additional studies are needed to evaluate the endometrial contribution to implantation failure and what population, if any, may benefit from additional endometrial testing.</span></span></p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"4 1","pages":"Pages 50-65"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49906535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current options to lower the cost of in vitro fertilization: a comprehensive review","authors":"Austin Gardner M.D. ,&nbsp;Kristen L. Smith M.D. ,&nbsp;Elizabeth Huuki B.S. ,&nbsp;Jacqueline Luizzi M.L.I.S., A.H.I.P. ,&nbsp;Deidre D. Gunn M.D. ,&nbsp;Sukhkamal B. Campbell M.D. ,&nbsp;Bruce D. Pier M.D.","doi":"10.1016/j.xfnr.2022.10.001","DOIUrl":"https://doi.org/10.1016/j.xfnr.2022.10.001","url":null,"abstract":"<div><p><span>Although the first successful in vitro fertilization (IVF) cycle occurred over 40 years ago, the financial cost of IVF remains steep and prevents several patients from pursuing this option for infertility treatment. Institutional coverage for IVF varies widely depending on state or country, and some individuals may ultimately encounter no financial support. In some cases, surgical intervention (instead of or before IVF) could provide a less costly option or optimize IVF success to decrease the number of cycles needed for a successful pregnancy. Alterations in the individual components of the IVF process may cumulatively drive down overall costs. Changing stimulation protocols, medication regimens, or the medications themselves used during IVF could lead to similar pregnancy rates at lower costs. The addition of adjuncts to traditional IVF stimulation may further elevate the success rate. Monitoring of the patient’s response to stimulation medications and the genetic testing of embryos can be applied more judiciously in certain patient populations. Automation in established practices, such as </span>intracytoplasmic sperm injection, may lead to decreased costs if broadly implemented. Patient-specific approaches using demographic and clinical factors to stratify patients on the basis of likelihood of success may enable providers to efficiently counsel patients to better financially plan for an IVF cycle.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"4 1","pages":"Pages 66-77"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49906534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vitro maturation of oocytes for fertility preservation: a comprehensive review","authors":"Michael Grynberg M.D., PhD. ,&nbsp;Nathalie Sermondade M.D., Ph.D. ,&nbsp;Ines Sellami M.D. ,&nbsp;Alexandra Benoit Ph.D. ,&nbsp;Anne Mayeur M.D. ,&nbsp;Charlotte Sonigo M.D., Ph.D.","doi":"10.1016/j.xfnr.2022.07.002","DOIUrl":"10.1016/j.xfnr.2022.07.002","url":null,"abstract":"<div><p><span>The development of oncofertility over the past decade has renewed the interest in in vitro maturation (IVM) because of the specificity of some oncologic situations that may prevent the feasibility of controlled ovarian hyperstimulation. Immature cumulus-oocyte complexes can be recovered from the small </span>antral follicles<span><span> in any phase of the menstrual cycle<span> within a very short time frame, offering the possibility of vitrifying mature oocytes or embryos after IVM in urgent situations or when stimulation is contraindicated. Cumulus-oocyte complexes and immature oocytes can be harvested either transvaginally or directly in the laboratory from extracorporeal ovarian tissue. Although IVM is no longer considered experimental as a result of safety studies, it relies on the extremely complex process of </span></span>oocyte maturation<span>. Despite some live births<span> obtained after IVM in the context of fertility preservation<span><span>, the lower developmental competence of in vitro–matured oocytes demonstrates the need to improve IVM culture systems. Recent advances in IVM systems may improve oocyte competence after IVM, thus tending to reduce the gap between IVM and ovarian stimulation outcomes. Moreover, to optimize the chances of conception in cancer survivors, the combination of IVM and </span>ovarian tissue cryopreservation is the preferred option when ovarian stimulation cannot be performed.</span></span></span></span></p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"3 4","pages":"Pages 211-226"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124458617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assisted reproductive technology or infertility: What underlies adverse outcomes? Lessons from the Massachusetts Outcome Study of Assisted Reproductive Technology","authors":"Judy E. Stern Ph.D ,&nbsp;Leslie V. Farland Sc.D. ,&nbsp;Sunah S. Hwang M.D., M.P.H., Ph.D. ,&nbsp;Dmitry Dukhovny M.D., M.P.H. ,&nbsp;Charles C. Coddington M.D. ,&nbsp;Howard J. Cabral Ph.D. ,&nbsp;Stacey A. Missmer Sc.D. ,&nbsp;Eugene Declercq Ph.D. ,&nbsp;Hafsatou Diop M.D., M.P.H.","doi":"10.1016/j.xfnr.2022.06.003","DOIUrl":"10.1016/j.xfnr.2022.06.003","url":null,"abstract":"<div><p>Assisted reproductive technology (ART, defined here as including only in vitro fertilization and related technologies) is associated with increased adverse pregnancy, neonatal, and childhood developmental outcomes, even in singletons. The comparison group for many of these studies has often been a fertile population that conceived without assistance. The Massachusetts Outcome Study of Assisted Reproductive Technology (MOSART) was initiated to define a subfertile population with which to compare ART outcomes. Over &gt;10 years, we have used the MOSART database to not only study pregnancy abnormalities and delivery complications but also evaluate ongoing health of women, infants, and children. This article will review studies from the MOSART in the context of how they compare with those of other investigations. We will present MOSART studies that identified the influence of ART and subfertility/infertility on adverse pregnancy (pregnancy hypertensive disorder, gestational diabetes, and placental abnormality) and delivery (preterm birth and low birth weight) outcomes as well as on maternal and child hospitalizations. We will provide evidence that although subfertility/infertility increases the risk of adverse outcomes, there is additional risk associated with the use of ART. Studies exploring the contribution of placental abnormalities as a factor adding to this increased ART-associated risk will be described.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"3 4","pages":"Pages 242-255"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733832/pdf/nihms-1834461.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10361445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in fertility preservation and barriers encountered by transgender individuals: where we started and have we progressed? A comprehensive review","authors":"Jawaria Amir M.D. ,&nbsp;Sonali Gupta M.D. ,&nbsp;Maria Amir B.B.A. ,&nbsp;Roohi Jeelani M.D.","doi":"10.1016/j.xfnr.2022.07.001","DOIUrl":"10.1016/j.xfnr.2022.07.001","url":null,"abstract":"<div><p><span><span>The transgender and nonbinary (TGNB) communities face unique challenges when deciding to forego or pursue fertility because of gender-affirming medical or surgical interventions. Options for these patients have historically been limited because of overt discrimination within the healthcare system. The purpose of this comprehensive review is to discuss trends in TGNB reproductive access and healthcare over the past 2 decades and survey past and current legislation regarding TGNB reproductive rights. To better identify barriers for TGNB population and trends regarding </span>fertility preservation, our review examines the attitudes, knowledge, and beliefs of both TGNB persons and healthcare providers. Second, we conduct a review of past and present legislation regarding reproductive rights and access related to TGNB care. The findings of our review demonstrate a failure to meet the standard of care for TGNB individuals in regard to fertility care, which likely contributes to the low uptake of fertility preservation services among this population. Furthermore, we find that healthcare providers must play a crucial role in advocating for systemic changes that can help alleviate barriers and provide equitable, gender-affirming care for TGNB individuals across the </span>reproductive health spectrum.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"3 4","pages":"Pages 280-296"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131515714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why are Black individuals disproportionately burdened with uterine fibroids and how are we examining this disparity? A systematic review","authors":"Mia A. Charifson M.A. ,&nbsp;Dorice Vieira M.A., M.P.H. ,&nbsp;Jacquelyn Shaw M.D. ,&nbsp;Siobhan Kehoe M.D. ,&nbsp;Gwendolyn P. Quinn Ph.D.","doi":"10.1016/j.xfnr.2022.07.004","DOIUrl":"10.1016/j.xfnr.2022.07.004","url":null,"abstract":"<div><h3>Objective</h3><p><span>To systematically review and summarize the literaure on nongenetic risk factors that may contribute to the racial disparity in </span>uterine fibroids (UF) that disproportionality impacts Black individuals at 2-3 times the rate of White individuals and how the racial disparity has been studied to date.</p></div><div><h3>Evidence Review</h3><p>The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol checklist guided the systematic review process. From January 1 to June 1, 2021, relevant articles were retrieved from PubMed, EMBASE, Web of Science, and Cochrane Library. Multiple investigators screened, assessed, extracted, and critically appraised the data.</p></div><div><h3>Results</h3><p><span>A total of 44 articles examined the relationship among UFs, race/ethnicity, and nongenetic risk factors, including cardiometabolic features, comorbidities, diet, chemical exposures, vitamin D levels, reproductive characteristics and socioeconomic factors, and life experiences. Most studies reported on the same 3 </span>cohort study populations, and there was inconsistent statistical reporting of the race/ethnicity, risk factors, and UF relationship.</p></div><div><h3>Conclusion</h3><p>Many potential risk factors related to the racial disparity in UF have been studied thus far. There is still little conclusive evidence regarding which risk factors are the greatest contributors to racial disparities in UF. Promising areas of research deserve greater attention and a greater diversity of study populations and analytical methods.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"3 4","pages":"Pages 256-279"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126655210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of matrix metalloproteinases as potential biomarkers for uterine fibroids","authors":"Kazuma Onishi M.D., M.P.H. ,&nbsp;Jiahui Zhang M.D. ,&nbsp;Jaime F. Blanck M.L.I.S., M.P.A. ,&nbsp;Bhuchitra Singh M.D., M.P.H., M.S., M.B.A.","doi":"10.1016/j.xfnr.2022.07.003","DOIUrl":"10.1016/j.xfnr.2022.07.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;&lt;span&gt;&lt;span&gt;Matrix metalloproteinases&lt;span&gt; (MMPs) are zinc-containing endopeptidases that play a critical role in &lt;/span&gt;&lt;/span&gt;morphogenesis&lt;span&gt;, wound healing, and tissue repair&lt;span&gt;. Uterine fibroids&lt;span&gt;&lt;span&gt; (UFs) are benign, fibrous smooth muscle tumors with excessive deposition of the &lt;/span&gt;extracellular matrix rich in interstitial collagen. This &lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;systematic review aims to rigorously assess current literature evaluating the role of MMPs in the pathoetiology of UFs.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Evidence Review&lt;/h3&gt;&lt;p&gt;A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted within PubMed, Embase, and Scopus databases. A data informationist was engaged to develop a comprehensive search strategy. Studies examining the MMP levels in leiomyoma and myometrium were searched. Two investigators independently screened and identified articles. Observational and interventional studies involving human subject research published in English up to January 2022 were included. Animal subject research, non-English articles, and reviews were excluded. The articles were assessed for risk of bias using the Newcastle-Ottawa scale. One investigator extracted the data, and a second investigator checked the accuracy. The extracted data were synthesized descriptively.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The initial search yielded 235 articles. After reviewing titles, abstracts, and full texts, 30 observational studies were judged to meet the inclusion criteria. The expression levels of MMPs in leiomyomas and myometrium varied among subtypes of MMPs. Nine studies reported elevated levels of MMP-2 expression and activity in leiomyoma cells compared with those in myometrium cells, whereas 1 study found a decreased level of MMP-2 expression. Two studies reported higher mRNA levels of MMPs in the secretory phase than in the proliferative phase. Two studies examined the relationship between MMP-1, -3, -9 genotypes and leiomyoma, and no association was found. One study examined the difference in MMP expression levels among leiomyoma, uterine smooth muscle tumor of uncertain malignant potential, and leiomyosarcoma&lt;span&gt;&lt;span&gt;&lt;span&gt; and found higher MMP-2 expression in leiomyosarcoma than in leiomyoma. The effects of estradiol on MMP expression and activity levels were examined in 2 studies. One study reported an upregulation of MMP-2 expression in leiomyomas by the administration of estradiol. Another study found that estradiol decreased MMP-2 activity in leiomyoma. We also identified studies that examined the effects of selective estrogen receptor modulators, gonadotropin-releasing hormone agonists, and &lt;/span&gt;selective progesterone receptor modulators on MMPs expression and activity &lt;/span&gt;in patients with UFs.&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;Data were mostly consistent regarding the expression and activity levels of MMPs in uterine leiomyomas. All ","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"3 4","pages":"Pages 227-241"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124364706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility and pregnancy outcomes after a uterine niche resection in women with and without infertility: a systematic review and meta-analysis","authors":"Carry Verberkt M.D. ,&nbsp;Saskia J.M. Klein Meuleman M.D. ,&nbsp;Johannes C.F. Ket ,&nbsp;Madelon van Wely M.D., Ph.D. ,&nbsp;Eva Bouwsma M.D., Ph.D. ,&nbsp;Judith A.F. Huirne M.D., Ph.D.","doi":"10.1016/j.xfnr.2022.05.003","DOIUrl":"https://doi.org/10.1016/j.xfnr.2022.05.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;To assess the effect of a uterine niche resection on fertility and pregnancy outcomes. We compared these outcomes in women with and without infertility, as we hypothesized that in the group with infertility, the presence of the niche may contribute to the failure to conceive. The focus on reproductive and pregnancy outcomes as well as the differentiation in study populations is novel and has not been a topic of research up until now.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Evidence Review&lt;/h3&gt;&lt;p&gt;The databases PubMed, Embase, and Web of Science were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until July 19, 2021. Randomized controlled trials (RCTs), cohort studies, case-control studies, and case series with at least 10 women were included if they reported fertility and/or pregnancy outcomes after any type of niche surgery among women with infertility or without the diagnosis of infertility. The risk of bias and quality of the included studies were assessed using the Cochrane risk-of-bias tool, the Newcastle-Ottawa Scale, and a set of niche-specific criteria. The primary outcome was live birth rate. The secondary outcomes included pregnancy and miscarriage rates, occurrence of an ectopic pregnancy, uterine dehiscence, and other obstetric complications. A meta-analysis was performed for the outcomes live birth, pregnancy, and miscarriage rates. The proportion with corresponding 95% confidence interval (CI) was calculated for each individual study, stratified for type of surgery and fertility status.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 3,825 records were identified, of which 21 articles were included (1 RCT, 1 case series, and 5 prospective and 14 retrospective cohort studies). The RCT compared a surgical intervention with expectant management, whereas the other studies had an observational design. Sixteen studies reported on fertility outcomes in women with infertility (n = 648), and 5 studies reported on fertility outcomes in women without a diagnosis of infertility (n = 237). The reported surgical procedures were hysteroscopic niche resection (HNR) (n = 14), vaginal niche resection (n = 7), laparoscopic niche resection (n = 7), and laparotomic niche resection (n = 2). The overall methodological quality of included studies was moderate to poor with a high risk of bias. The statistical heterogeneity among the included studies ranged between 0 and 88%. Overall, the effect of a niche resection on the live birth rate was lower in women without infertility than in women with infertility: 36% (95% CI, 26 %–46%) vs. 54% (95% CI, 44%–64%).The live birth rates per different operative technique showed similar trends: HNR, 52% (95% CI, 40%–64%) vs. 55% (95% CI, 38%–71%); laparoscopic niche resection, 36% (95% CI, 25%–48%) vs. 42% (95% CI, 30%–55%); and vaginal niche resection, 25% (95% CI, 9%–46%) vs. 60% (95% CI, 52%–67%). The only RCT performed showed","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":"3 3","pages":"Pages 174-189"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666571922000068/pdfft?md5=45b3b2be112c9a70b7a01eff9c5657a5&pid=1-s2.0-S2666571922000068-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91634640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}