Therapeutic advances in reproductive health最新文献

{"title":"The stair-step approach in treatment of anovulatory PCOS patients.","authors":"Eran Horowitz, 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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}

{"title":"The obligate need for accuracy in reporting preclinical studies relevant to clinical trials: autologous germline mitochondrial supplementation for assisted human reproduction as a case study.","authors":"Jonathan L Tilly,&nbsp;Dori C Woods","doi":"10.1177/2633494120917350","DOIUrl":"https://doi.org/10.1177/2633494120917350","url":null,"abstract":"<p><p>A now large body of work has solidified the central role that mitochondria play in oocyte development, fertilization, and embryogenesis. From these studies, a new technology termed autologous germline mitochondrial energy transfer was developed for improving pregnancy success rates in assisted reproduction. Unlike prior clinical studies that relied on the use of donor, or nonautologous, mitochondria for microinjection into eggs of women with a history of repeated <i>in vitro</i> fertilization failure to enhance pregnancy success, autologous germline mitochondrial energy transfer uses autologous mitochondria collected from oogonial stem cells of the same woman undergoing the fertility treatment. Initial trials of autologous germline mitochondrial energy transfer during - <i>in vitro</i> fertilization at three different sites with a total of 104 patients indicated a benefit of the procedure for improving pregnancy success rates, with the birth of children conceived through the inclusion of autologous germline mitochondrial energy transfer during <i>in vitro</i> fertilization. However, a fourth clinical study, consisting of 57 patients, failed to show a benefit of autologous germline mitochondrial energy transfer-<i>in vitro</i> fertilization <i>versus in vitro</i> fertilization alone for improving cumulative live birth rates. Complicating this area of work further, a recent mouse study, which claimed to test the long-term safety of autologous mitochondrial supplementation during <i>in vitro</i> fertilization, raised concerns over the use of the procedure for reproduction. However, autologous mitochondria were not actually used for preclinical testing in this mouse study. The unwarranted fears that this new study's erroneous conclusions could cause in women who have become pregnant through the use of autologous germline mitochondrial energy transfer during-<i>in vitro</i> fertilization highlight the critical need for accurate reporting of preclinical work that has immediate bearing on human clinical studies.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120917350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38027360","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":"Patient perspectives and experiences with <i>in vitro</i> fertilization and genetic testing options.","authors":"Erin Rothwell,&nbsp;Brandy Lamb,&nbsp;Erin Johnson,&nbsp;Shawn Gurtcheff,&nbsp;Naomi Riches,&nbsp;Melinda Fagan,&nbsp;Maya Sabatello,&nbsp;Erica Johnstone","doi":"10.1177/2633494119899942","DOIUrl":"https://doi.org/10.1177/2633494119899942","url":null,"abstract":"<p><strong>Objective: </strong>Decision-making and patient experiences with embryo selection during <i>in vitro</i> fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using <i>in vitro</i> fertilization and genetic technologies.</p><p><strong>Methods: </strong>Interviews (<i>n</i> = 37) were conducted among female patients who had undergone <i>in vitro</i> fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts.</p><p><strong>Results: </strong>Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman's contributions and questions about embryo viability. Patient experiences with genetic technologies during <i>in vitro</i> fertilization played a significant role within these results.</p><p><strong>Conclusion: </strong>The emotional and psychological impacts of infertility during <i>in vitro</i> fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during <i>in vitro</i> fertilization treatment.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494119899942","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38027436","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":"Characteristics of polycystic ovary syndrome throughout life.","authors":"Yvonne V Louwers,&nbsp;Joop S E Laven","doi":"10.1177/2633494120911038","DOIUrl":"https://doi.org/10.1177/2633494120911038","url":null,"abstract":"<p><p>Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. It is a complex disease in which genetic, endocrine, environmental, and behavioral factors are intertwined, giving rise to a heterogeneous phenotype with reproductive, metabolic, and psychological characteristics. Polycystic ovary syndrome affects women's health and their quality of life across the life course. During different life stages, the polycystic ovary syndrome phenotype can change, which requires a personalized diagnostic approach and treatment. Polycystic ovary syndrome is a major cause of anovulatory infertility; this disorder is also associated with hirsutism and acne. Diagnosing polycystic ovary syndrome during adolescence is challenging because the polycystic ovary syndrome criteria include normal physiological events that occur during puberty. With increasing age, the syndrome evolves from a reproductive disease to a more metabolic disorder. Along with metabolic disturbances, including insulin resistance and abnormalities of energy expenditure, polycystic ovary syndrome is recognized as a major risk factor for the development of type 2 diabetes and cardiovascular disease in later life. Moreover, there is evidence for familial clustering of endocrine and metabolic features of polycystic ovary syndrome. Environmental factors such as diet and obesity appear to contribute to the phenotype. Treatment should be tailored to the specific concerns and needs of the individual patient and involves restoring fertility, treatment of the metabolic complaints, treatment of androgen excess, and providing endometrial protection. The complexity of the disorder, and the impact on quality of life, requires a timely diagnosis, screening for complications, and management strategies for the long-term health issues associated with polycystic ovary syndrome. The syndrome remains underdiagnosed, and women experience significant delays to diagnosis.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2633494120911038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38027362","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":"What is new in the landscape of insulin-sensitizing agents for polycystic ovary syndrome treatment.","authors":"Daniela Romualdi, Valeria Versace, Antonio Lanzone","doi":"10.1177/2633494120908709","DOIUrl":"10.1177/2633494120908709","url":null,"abstract":"<p><p>Polycystic ovary syndrome, the most common gynecological endocrinopathy, is burdened with a state of hyperinsulinemia and insulin resistance in 50-80% of affected women. Wherever the origin of these metabolic abnormalities lies, their pathogenetic role in determining, perpetuating, and worsening the clinical traits of the syndrome is ascertained. Many studies have already highlighted possible mechanisms: hyperinsulinemia and insulin resistance may contribute to hyperandrogenemia, chronic anovulation, and other comorbidities of the syndrome by differentially affecting the endocrine glands (ovaries, adrenals, and pituitary) and peripheral tissues (fat mass and skeletal muscle). Based on these evidences, in the past years, thorough research has been focused on the possible role of insulin-sensitizing agents in the treatment of polycystic ovary syndrome. Many compounds were tested to verify their efficacy against polycystic ovary syndrome-related metabolic dysfunction, both relying on previous acquired experiences in the field of diabetes mellitus and experimenting new agents, in particular, those belonging to the class of nutraceuticals. We sought to summarize the most relevant aspects of insulin-sensitizing treatments in polycystic ovary syndrome, by reporting the relevant literature on this topic and by keeping an attentive eye on the newly published international guidelines on polycystic ovary syndrome 2018. This overview encompasses metformin, thiazolidinediones, inositols, alpha-lipoic acid, and GLP1-R analogues. Starting from the analysis of the mechanisms of action, we anchored to the state of the art of the use of these drugs in polycystic ovary syndrome, to the most recent evidences for clinical practice and to the remaining open questions around indications, dose, treatment schedules, and side effects.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2020-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/25/10.1177_2633494120908709.PMC7236839.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37958089","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}