Therapeutic advances in reproductive health最新文献

{"title":"Serum estradiol levels in infertile men with non-obstructive azoospermia.","authors":"Nader Salama, Saeed Blgozah","doi":"10.1177/2633494120928342","DOIUrl":"10.1177/2633494120928342","url":null,"abstract":"<p><strong>Purpose: </strong>To report the different patterns of estradiol levels in infertile men with non-obstructive azoospermia and correlate these levels with their clinical and laboratory findings.</p><p><strong>Materials and methods: </strong>A retrospective study was launched, and a retrieval of data for infertile men with non-obstructive azoospermia (<i>n</i> = 166) and fertile controls (<i>n</i> = 40) was performed. The retrieved data included demographics, clinical findings, scrotal duplex, semen analysis, and hormonal assay (testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol).</p><p><strong>Results: </strong>Our findings showed a wide spectrum of estradiol concentrations. The patients were arranged into three groups (high, normal, and low estradiol groups). The normal estradiol group was the most prevalent (71.1%). Testosterone, gonadotrophins, testicular volumes, and the number of patients with jobs in polluted workplaces showed significant differences among the study groups (<i>p</i> = 0.001, <0.001, <0.001, and 0.004, respectively). Age, body mass index, varicocele prevalence, prolactin, and smoking habits did not show any significant differences among the groups. Obesity was lacking in the low estradiol group, but it had significantly higher prevalence in the normal (<i>p</i> = 0.013) or high group (<i>p</i> = 0.023) compared with the controls.</p><p><strong>Conclusion: </strong>Serum estradiol, in infertile men with non-obstructive azoospermia, may be present at different levels. It is recommended that estradiol be measured in infertile men with non-obstructive azoospermia when there is an alteration in testosterone concentration, obesity, a polluted workplace occupation, or before trying hormonal therapy. Extended studies are highly recommended to provide a clear clue whether alterations in estradiol concentrations in men with non-obstructive azoospermia are the cause or a consequence of the condition.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120928342"},"PeriodicalIF":0.0,"publicationDate":"2020-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/30/10.1177_2633494120928342.PMC7325549.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38138675","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":"Risk factors for women's non-utilization of decentralized primary health care facilities for postnatal care in rural western Ethiopia.","authors":"Habtamu Tolera,&nbsp;Tegegne Gebre-Egziabher,&nbsp;Helmut Kloos","doi":"10.1177/2633494120928340","DOIUrl":"https://doi.org/10.1177/2633494120928340","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Evidence suggests postnatal care contributes to reductions in maternal mortality. In Ethiopia, the proportion of women who do not utilize postnatal care after birth is high and the frequency of postnatal checks falls short of the four visits recommended by World Health Organization. This study examined risk factors associated with non-utilization of decentralized local health facilities, namely, health posts, health centers, and a primary hospital, for postnatal care services in Gida Ayana &lt;i&gt;Woreda&lt;/i&gt; in rural western Ethiopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this study, 454 mothers were examined for the following risk factors: &lt;i&gt;kebele&lt;/i&gt; (the smallest administrative unit in Ethiopia) in which decentralized health care facilities were located, postnatal woman's age, antenatal care service visit, experience of postnatal complications, knowledge of postnatal complications, knowledge of the recommended number of postnatal care visits, knowledge of the availability/provision of postnatal care, and health extension workers' home visits. Bivariate and multivariable logistic regression analyses were applied to identify predictors of non-utilization of decentralized local facilities for postnatal care services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over half (55.7%) of the women did not utilize postnatal care within 42 days of delivery, and only 10.0% utilized the care considered appropriate according to World Health Organization guidelines. After adjusting for various potential confounding factors, we found the following risks to be strongly associated with non-utilization of decentralized health care facilities for postnatal care services: some outer rural administrative decentralization entities such as Angar, Lalistu, and Ejere &lt;i&gt;kebeles&lt;/i&gt;; age 35 years or older (adjusted odds ratio = 3.4, 95% confidence interval: 1.4-8.3), not receiving antenatal care during this pregnancy (adjusted odds ratio = 2.0, 95% confidence interval: 1.1-3.7), no experience of any postnatal complications (adjusted odds ratio = 3.3, 95% confidence interval: 1.7-6.4), and no knowledge of at least one postnatal complication (adjusted odds ratio = 2.0, 95% confidence interval: 1.2-3.3). Risk factors highly but less strongly associated with women's non-utilization of postnatal care services were no knowledge of the standard number of postnatal care visits recommended, no knowledge about the availability/provision of services at a local health facility, and no home visit from health extension worker by day 3 post-delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The risk factors for women's non-utilization of decentralized health care facilities for postnatal care identified in this study need to be considered in interventions for enhancing the utilization of the service and reducing maternal and newborn deaths in rural western Ethiopia. Strengthening of postnatal care services, especially in the more remote &lt;i&gt;kebeles&lt;/i&gt;, should include upgrading o","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120928340"},"PeriodicalIF":0.0,"publicationDate":"2020-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120928340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38136426","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":"The insulin signaling pathway is dysregulated in cumulus cells from obese, infertile women with polycystic ovarian syndrome with an absence of clinical insulin resistance.","authors":"Mauricio B Chehin,&nbsp;Renato Fraietta,&nbsp;Aline R Lorenzon,&nbsp;Tatiana C S Bonetti,&nbsp;Eduardo L A Motta","doi":"10.1177/2633494120906866","DOIUrl":"https://doi.org/10.1177/2633494120906866","url":null,"abstract":"<p><strong>Methods: </strong>This is a cohort study, conducted at a university-based reproductive medicine center and private reproductive medicine center that aimed to evaluate granulosa cumulus cell gene expression in the insulin signaling pathway in Polycystic Ovary Syndrome (PCOS) patients undergoing in vitro fertilization (IVF) treatment and to compare the cumulus gene expression between normal weight and obese women without clinical insulin resistance. Fifteen PCOS patients, nine normal weight patients and six obese patients presenting normal HOMA IR (Homeostasis Model Assessment-Insulin Resistance), participated. Patients underwent oocyte retrieval for IVF and after the procedure, granulosa cumulus cells were removed from the oocytes for RNA extraction. Quantitative polymerase chain reaction (PCR) array analysis of 84 genes from insulin signaling pathway was conducted. The results were expressed as fold up- or fold down-expression in obese patients compared with normal weight patients. Any fold change ⩾3 or ⩽3 and any <i>p</i> ⩽ 0.05 were considered statistically significant.</p><p><strong>Results: </strong>There were 10 genes that were overexpressed in obese compared with normal weight women, BCL2L1, BRAF, CBL, DOK1, FBP1, FRS2, MTOR, PCK2, RPS6KA1, and SORBS1, that had a fold change ⩾3 and <i>p</i> ⩽ 0.05.</p><p><strong>Discussion: </strong>In the obese group, the overexpressed genes are mainly responsible for the proliferation and differentiation of cumulus cells during oocyte maturation, insulin resistance, apoptosis regulation, and glucose metabolism during early embryogenesis, suggesting that in the follicular environment, insulin resistance is present even in the absence of clinical signs.</p><p><strong>Conclusion: </strong>Together, our findings and the related literature suggest that those alterations may be associated with the worse prognosis of follicular development and oocyte maturation observed in PCOS obese women.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120906866"},"PeriodicalIF":0.0,"publicationDate":"2020-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120906866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38100530","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":"Ejaculatory abstinence in semen analysis: does it make any sense?","authors":"Shah Dupesh, Natarajan Pandiyan, Radha Pandiyan, Jeeva Kartheeswaran, Bhaskar Prakash","doi":"10.1177/2633494120906882","DOIUrl":"10.1177/2633494120906882","url":null,"abstract":"<p><strong>Background: </strong>The precise effect of ejaculatory abstinence on semen parameters is highly debatable, especially among subfertile men. Previous studies on effect of abstinence time on different semen parameters have reported controversial results. The aim of this study was to retrospectively assess the variance of semen parameters with different periods of ejaculatory abstinence among both a population of normozoospermic (<i>n</i> = 1621) and oligozoospermic (<i>n</i> = 416) Tamil men, presenting to a fertility clinic for an infertility evaluation (<i>N</i> = 2037).</p><p><strong>Materials and methods: </strong>A retrospective analysis of 2037 semen analysis reports involved grouping patients based on their ejaculatory abstinence, that is, <24 h, 1 to 2 days, 3 to 7 days, 8 to 15 days, 16 to 30 days, and >30 days. All semen parameters were assessed as per the World Health Organization (WHO, 2010) recommended guidelines. The unpaired two-tailed <i>t</i>-test and Welch's analysis of variance (ANOVA) combined with Games-Howell post hoc test were used for statistical analysis. A <i>p</i> value <0.05 was considered to be statistically significant.</p><p><strong>Result: </strong>A retrospective analysis of data (<i>N</i> = 2037) identified no statistically significant differences in semen parameters of sperm concentration, percentage of progressively motile sperm, and normal sperm morphology in both normozoospermic and oligozoospermic individuals across different groups of abstinence. Semen volume was the only parameter that showed a statistically significant difference in both groups (<i>p</i> < 0.0001). In both normozoospermic and oligozoospermic men, the group with <24 h abstinence had the highest mean percentage of progressively motile sperm and normal sperm morphology.</p><p><strong>Conclusion: </strong>The findings of this study suggest that ejaculatory abstinence may be highly arbitrary, and the recommendation of a strict 2- to 7-day abstinence per the WHO may be liberalized. In both normozoospermic and oligozoospermic men, semen parameters associated with an abstinence of <24 h were found to be noninferior as compared to longer ejaculatory abstinence intervals. These findings support in eliminating conservative recommendations as far as abstinence is concerned and suggest that patients may be asked to collect a semen sample on the day they present for an infertility evaluation, regardless of abstinence.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120906882"},"PeriodicalIF":3.1,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/e8/10.1177_2633494120906882.PMC7297125.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38096372","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":"Laboratory and clinical management of leukocytospermia and hematospermia: a review.","authors":"Kajal Khodamoradi,&nbsp;Manish Kuchakulla,&nbsp;Manish Narasimman,&nbsp;Zahra Khosravizadeh,&nbsp;Aleena Ali,&nbsp;Nancy Brackett,&nbsp;Emad Ibrahim,&nbsp;Ranjith Ramasamy","doi":"10.1177/2633494120922511","DOIUrl":"https://doi.org/10.1177/2633494120922511","url":null,"abstract":"<p><p>Leukocytospermia and hematospermia are defined as the presence of abnormally high white blood cell and red blood cell concentration in the semen, respectively. Numerous etiologies and various implications on fertility have been identified. In a small proportion of men, the presence of white blood cells or red blood cells can adversely affect sperm quality by the production of reactive oxygen species. Several methods have been used to assess the presence of white blood cells and red blood cells in samples, such as identification of round cells, immunohistochemical staining using monoclonal antibodies, the Endtz test, the peroxidase test, and flow cytometry or microscopy. In addition, techniques have been identified to separate sperm samples from white blood cells and red blood cells for cryopreservation to improve outcomes in assisted reproductive technology. In this review, laboratory and clinical management of leukocytospermia and hematospermia are discussed. Currently available diagnostic methods and treatment options are outlined, and available optimal cryopreservation techniques for samples with white blood cells or red blood cells are summarized.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120922511"},"PeriodicalIF":0.0,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120922511","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38078198","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":"The stair-step approach in treatment of anovulatory PCOS patients.","authors":"Eran Horowitz,&nbsp;Ariel Weissman","doi":"10.1177/2633494120908818","DOIUrl":"https://doi.org/10.1177/2633494120908818","url":null,"abstract":"Clomiphene citrate (CC) is a widely accepted first-line treatment for anovulatory patients with polycystic ovarian syndrome (PCOS). The current practice is to prescribe CC with gradual dose increments until ovulation is achieved. Typically, progesterone withdrawal bleeding is induced between each dose increment and before the commencement of gonadotropin therapy in CC-resistant patients. It has been recently suggested that dose increments of CC can be administered once failure to induce ovulation at a certain dose has been documented, without induction of progesterone withdrawal bleeding, and this approach has been nicknamed the clomiphene-citrate stair-step (CC-SS) protocol. The same principle has been found feasible before introducing gonadotropin therapy in CC-resistant PCOS patients. Our objective was to review the world literature on the CC-SS protocol and to summarize our own experience with extending the CC-SS approach to initiation of gonadotropin therapy. Studies on CC-SS protocol (n = 4) have found that this approach leads to a significant reduction of the time to ovulation and to an increased ovulation rate. In our own retrospective case series, 18 CC-resistant PCOS patients initiated gonadotropin stimulation without induction of progesterone withdrawal bleeding, using the chronic low-dose regimen. The time to ovulation in the study group was 54.2 ± 6.2 days, while the estimated time to ovulation calculated according to the traditional approach was approximately 110 days. The clinical pregnancy rate was 44% (8/18), and all pregnancies were singletons. One patient miscarried; hence, the live birth rate was 38.9% (7/18). In summary, the CC-SS approach and its extension to the initiation of gonadotropin therapy results in considerable reduction of the time to ovulation, and favorable ovulation rates and reproductive outcome. Large-scale confirmation of these findings by properly designed randomized controlled trials may lead to a change of practice in the treatment of anovulatory infertility in PCOS patients, allowing simplification of treatment and a shorter time to ovulation and pregnancy.","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120908818"},"PeriodicalIF":0.0,"publicationDate":"2020-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120908818","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38027437","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":"Studies on the basic issues relevant to sperm cryopreservation in humans.","authors":"Huanhuan Hu,&nbsp;Xiaowei Shi,&nbsp;Guojie Ji,&nbsp;Rui Liu,&nbsp;Jing Zhang,&nbsp;Han Zhang,&nbsp;Mingwen Li","doi":"10.1177/2633494120909375","DOIUrl":"https://doi.org/10.1177/2633494120909375","url":null,"abstract":"<p><p>Rapid freezing and vitrification are becoming popular for sperm freezing in humans; however, basic and critical issues relevant to sperm cryopreservation remain to be resolved. The aims of the present study were to study the effects of osmolality of freezing medium, sperm concentrations, thawing methods, and sugars (sucrose and trehalose) on sperm motility and DNA integrity by rapid freezing using 0.5 ml standard straws loaded with 100 µl sperm each. The results showed that (1) the post-thaw recovery rates of total motility and progressive motility of sperm cryopreserved in freezing medium containing 0.25 M sucrose with 442 mOsm/kg osmolality were significantly higher (<i>p</i> < 0.05) than that of sperm cryopreserved in freezing medium containing 0.25 M sucrose with 536 mOsm/kg osmolality (36.5 ± 2.8% and 36.9 ± 1.7% <i>versus</i> 30.4 ± 1.9% and 30.3 ± 2.9%, respectively), (2) cryopreservation of both total and progressive motilities was not significantly affected (<i>p</i> > 0.05) by sperm concentrations in the range from 5 to 20 × 10⁶ sperm/ml, (3) thawing method 37°C for 2 min was better than 42°C for 15 s in terms of post-thaw recovery rates of both total and progressive motilities (<i>p</i> < 0.05), (4) 0.25 M trehalose was better than 0.25 M sucrose in cryopreserving both total and progressive motilities (<i>p</i> < 0.05), and (5) sperm nuclear DNA is relatively resistant to the changes of the above factors compared with sperm motility. It was concluded that human sperm can be best cryopreserved by rapid freezing using 0.25 M sucrose or trehalose with osmolality 442 to 457 mOsm/kg at high sperm concentration followed by thawing at 37°C. Trehalose is a stronger cryoprotectant than sucrose for sperm cryopreservation.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120909375"},"PeriodicalIF":0.0,"publicationDate":"2020-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120909375","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38027441","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":"Reaching women with obesity to support weight loss before pregnancy: feasibility and qualitative assessment.","authors":"Denise Simon,&nbsp;Anjali J Kaimal,&nbsp;Emily Oken,&nbsp;Marie-France Hivert","doi":"10.1177/2633494120909106","DOIUrl":"https://doi.org/10.1177/2633494120909106","url":null,"abstract":"<p><strong>Background: </strong>We sought to assess attitudes toward weight and barriers to recruitment of women with obesity for a potential preconception weight-loss/lifestyle modification intervention.</p><p><strong>Methods: </strong>We performed a qualitative study involving women of reproductive age (18-45) with obesity (body mass index ⩾30 kg/m²) who were considering a pregnancy in the next 2 years. We evaluated four methods of recruitment. We used previously validated survey questions to evaluate risk perceptions. In a subset, we used semistructured interviews for topics that required more in-depth information: domains included attitudes toward weight-related issues, intentions, and barriers to engagement in a structured weight-loss program. We performed qualitative analyses of interview transcripts using immersion crystallization.</p><p><strong>Results: </strong>We recruited the majority (80/82, 98%) of women using e-recruitment strategies. Eighty-one women filled out the survey and 39 completed an interview. Three-quarters of the women surveyed (60 of 81) reported attempts to lose weight in the past year and 77% (68/81) of survey respondents cited jobs and work schedules as a barrier to adopting healthy habits. More than 87% (34 of 39) of women interviewed reported willingness to participate in a structured weight-loss program prior to getting pregnant. Of these, 74% (25 of 34) stated they would consider delaying their attempts at a future pregnancy in order to participate in such a program.</p><p><strong>Conclusions: </strong>E-recruitment is a promising strategy for recruitment for preconception weight-loss and lifestyle modification program. Most women state a willingness to delay pregnancy attempts to participate in a weight-loss program.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120909106"},"PeriodicalIF":0.0,"publicationDate":"2020-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120909106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38027357","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":"Surgical adhesions among women undergoing laparoscopic gynecological surgery with or without adhesiolysis - prevalence, severity, and implications: retrospective cohort study at a University Hospital.","authors":"Naser Al-Husban,&nbsp;Yousef Elayyan,&nbsp;Malab El-Qudah,&nbsp;Bayan Aloran,&nbsp;Rima Batayneh","doi":"10.1177/2633494120906010","DOIUrl":"https://doi.org/10.1177/2633494120906010","url":null,"abstract":"<p><strong>Objective: </strong>To find out the prevalence of adhesions, severity, and their relation to the current clinical scenario and to the type of previous surgery.</p><p><strong>Methods and materials: </strong>A retrospective study of patients who already had different previous abdominopelvic surgery and subsequently underwent gynecological laparoscopic surgery for various indications. The patients' clinical and operative notes were reviewed and analyzed.</p><p><strong>Results: </strong>There were 654 procedures performed. The most common indication for the laparoscopic surgery was secondary infertility 23.5%, followed by adnexal lesions 22.0% and primary infertility 19.6%. Intraoperative adhesions were found in 45.3%. Adhesions were deemed relevant to the clinical scenario in 21.3%. Patients who had a previous history of open (traditional) surgery were more likely to be found with adhesions in comparison with patients with history of laparoscopic surgery (odds ratio: 2.7, 95% confidence interval: 1.4-5.3, <i>p</i> = 0.0025). The presence of adhesions was found to be strongly associated with previous abdominopelvic surgery than non-abdominopelvic surgery (odds ratio: 4.3, <i>p</i> = 0.0078, 95% confidence interval: 1.5-12.5). The most common location of the adhesions was abdominal (36.1%), mixed abdominal and pelvic (35.1%), and pelvic adhesions (28.1%). Severe adhesions were found in 36.1%; 13.6% of converted laparoscopy to open surgery was due to adhesions. Cesarean sections were significantly associated with adhesions. Patients who had cesarean sections were more likely to have adhesions than those who had not (odds ratio: 5.7, 95% confidence interval: 3.8-8.6, <i>p</i> < 0.0001). Adhesiolysis was done without complications in 19.6% of patients with adhesions.</p><p><strong>Conclusion: </strong>Adhesions were prevalent in gynecological patients with previous abdominopelvic surgery. They were a significant contributor to the gynecological and reproductive issues. To minimize the risk of postoperative adhesions, laparoscopic approach should be encouraged instead of traditional surgery and rates of cesarean section should be reduced. Further high-quality studies are needed to establish conclusion and practical guidance toward the use of adhesion barriers.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120906010"},"PeriodicalIF":0.0,"publicationDate":"2020-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120906010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38027439","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":"Attitudes and experiences of health care professionals when caring for transgender men undergoing fertility preservation by egg freezing: a qualitative study.","authors":"Gabriela Armuand,&nbsp;Cecilia Dhejne,&nbsp;Jan I Olofsson,&nbsp;Margareta Stefenson,&nbsp;Kenny A Rodriguez-Wallberg","doi":"10.1177/2633494120911036","DOIUrl":"https://doi.org/10.1177/2633494120911036","url":null,"abstract":"<p><strong>Background: </strong>As gender-affirming treatment may have a negative impact on fertility, reproductive health counseling to patients seeking medical or surgical gender-affirming treatment should be provided, including the option to undergo fertility preservation (FP). Experiences of transgender men undergoing FP treatments aimed at oocyte freezing have reported a negative impact of the treatments on gender dysphoria. No previous studies have investigated the experiences of health care professionals' (HCP) when caring for transgender men undergoing such treatments.</p><p><strong>Aim: </strong>The aim of this study was to investigate HCP's attitudes and experiences when meeting transgender men undergoing FP through oocyte freezing.</p><p><strong>Methods: </strong>Individual interviews were conducted in 2016 with 13 HCPs working at a Reproductive Medicine clinic in Sweden. Data were analyzed by thematic content analysis.</p><p><strong>Results: </strong>The main theme found, <i>How to maintain professionalism</i>, showed that HCPs experienced important challenges to their professionalism when their preconceived opinions and values about gender and transgender were confronted.</p><p><strong>Discussion: </strong>Our findings demonstrate the need of continuous efforts on assessing learning needs as well as addressing preconceived opinions and values of HCP. By gaining knowledge and self-confidence in the care of transgender individuals undergoing FP, a professional care for transgender people can be achieved and a safe environment can be established for the patients. This in turn may alleviate some of the distress that may arise when transgender men undergo FP.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":"14 ","pages":"2633494120911036"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120911036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38027356","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}