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1.
BJOG ; 127(2): 208-216, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31529767

RESUMO

OBJECTIVE: The objective of this study was to use high-throughput sequencing to describe the vaginal eukaryotic DNA virome in patients undergoing in vitro fertilisation (IVF) to examine associations between the vaginal virome, antibiotic exposure and IVF outcomes. DESIGN: Prospective exploratory study. SETTING: Single academic fertility centre. POPULATION: Subfertile women age 18-43 years undergoing their first IVF cycle with a fresh embryo transfer. METHODS: The primary exposure was prophylactic azithromycin or no azithromycin before IVF. A mid-vaginal swab was obtained at the time of embryo transfer for virome analysis. MAIN OUTCOME MEASURES: The primary outcomes compared between exposure groups were characteristics of vaginal virome and clinical pregnancy rates. Secondary outcomes were virome associations with number of oocytes retrieved, number of blastocysts and implantation rate. RESULTS: Twenty-six women contributed a vaginal swab before embryo transfer. There were no significant differences in IVF outcomes between azithromycin groups. There was no association between viral diversity and clinical pregnancy overall. A higher diversity of herpesviruses and α-papillomaviruses was observed in samples from the azithromycin-treated group compared with the no azithromycin group (P = 0.04). In women that received azithromycin, viral diversity was higher in the group that did not achieve clinical pregnancy compared with those who did (P = 0.06). CONCLUSIONS: We demonstrate that the vaginal eukaryotic virome in women undergoing IVF is associated with antibiotic exposure. Additionally, we demonstrate an inverse trend between viral diversity and pregnancy, with a higher number of viruses detected associated with failure to achieve clinical pregnancy in the azithromycin group. TWEETABLE ABSTRACT: Higher viral diversity is associated with prophylactic antibiotic exposure in subfertile women undergoing IVF.


Assuntos
Eucariotos/fisiologia , Fertilização In Vitro , Infertilidade/terapia , Microbiota , Vagina/virologia , Adulto , Antibacterianos/uso terapêutico , DNA Viral/fisiologia , Transferência Embrionária , Feminino , Herpesviridae , Humanos , Microbiota/genética , Microbiota/imunologia , Papillomaviridae , Gravidez , Estudos Prospectivos , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/imunologia , Análise de Sequência de DNA , Vagina/microbiologia
2.
BMC Public Health ; 19(1): 1548, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752817

RESUMO

BACKGROUND: Research highlighted that Stressful Life Events have high incidence among infertile patients and significant impact on physical and medical parameters related to reproductive functions, but their potential role among factors influencing the infertile patients' perception of fertility-related Quality of Life (QoL) has not been explored. The present study aims to investigate the associations of Stressful Life Events (Stressful events in the family of origin, In family pre-existing pregnancy difficulties, Health problems in childhood) with perceived fertility-related QoL in women attending infertility treatments, examining the potential moderating role of adopted coping strategies and perceived couple's dyadic adjustment. METHODS: A questionnaire consisting of Socio-demographics and Infertility-related characteristics, Stress-inducing events in the couples' lives Questionnaire (FLS), Coping Orientations to Problem Experienced (COPE), Dyadic Adjustment Scale (DAS), and Core and Treatment subscales of Fertility Quality of Life (FertiQoL) was administered to 266 women attending infertility treatments. A descriptive correlational design with cross-sectional comparison was used. Results Logistic Regression Analyses after adjusting for socio-demographic and infertility-related characteristics revealed that women who reported Stressful events in the family of origin and In family pre-existing pregnancy difficulties were more likely to report lower levels of perceived Core QoL, while women who reported Health problems in childhood were more likely to report lower levels of perceived Treatment QoL. Couple's dyadic adjustment and specific coping strategies were significantly associated with perceived Core and Treatment QoL and they also significantly moderated the associations between stressful life events and perceived QoL. CONCLUSIONS: Data provided original evidence on the strong association between stressful life events and perceived fertility-related QoL also highlighting individual and couples' resources to define counselling interventions with women attending infertility treatments.


Assuntos
Adaptação Psicológica , Infertilidade/psicologia , Infertilidade/terapia , Relações Interpessoais , Qualidade de Vida/psicologia , Cônjuges/psicologia , Estresse Psicológico/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cônjuges/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
3.
Sex Reprod Health Matters ; 27(2): 1610278, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31533588

RESUMO

Through the examination of pronatalist policies introduced in South Korea within the last decade, the aim of this commentary is to assess how such policies could harm women's reproductive health if they are practiced only for the purpose of population control. South Korea is a country with one of the lowest fertility rates in the world, and to increase population growth, since 2005, the Korean government has heavily regulated and promoted the use of reproductive technologies, including abortion technologies and assisted reproductive technologies (ARTs). This represents a dramatic shift from South Korea's historically antinatalist position: from the 1960s to the 1980s, abortion was widely practiced and encouraged by the government to reduce population growth, and the use of ARTs went unsupported by the government. However, when the total fertility rate reached 1.08 in 2005, the government strictly prohibited abortion and started promoting the use of ARTs to increase the nation's birthrate. Although under the current pronatalist policies, the Korean government has provided unprecedented incentives to couples seeking to have children, such as expanded maternal/paternal leave and childcare benefits, ironically, reproductive health indicators, such as maternal mortality and infant mortality, have not improved and, in some cases, have even worsened because the pronatalist policies fail to consider women's reproductive health and rights issues.


Assuntos
Infertilidade/terapia , Política Pública , Técnicas de Reprodução Assistida , Feminino , Fertilidade , Humanos , Controle da População , Saúde Reprodutiva , República da Coreia
4.
Reprod Health ; 16(1): 126, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426818

RESUMO

BACKGROUND: In Indonesia infertility affects 10-15% of reproductive-age couples. In addition to medical problem, infertility in Indonesia poses significant social problem. Childlessness is often stigmatized as a failure which victimizes couples, moreover the females. Despite the high prevalence, there is no fertility awareness education which further passes down the common myth, misperception, and negative attitude towards infertility treatment in Indonesian society. OBJECTIVE: This study aims to reveal the knowledge, myth, and attitude towards infertility, likewise acceptance towards infertility treatment options. METHOD: Cross-sectional study using standardized questionnaire was done to 272 individuals consisted of two parallel groups: Jakarta and Sumba representing urban and rural population respectively. Participants were all outpatients above 18 years old who visited the healthcare centers from February 2017 to June 2017. RESULTS: Knowledge on biological and lifestyle risk factors of infertility among Jakarta and Sumba groups were comparable. However, belief in supernatural causes of infertility is remarkable in Sumba population. There is a common misconception on the use of contraception as risk factors of infertility in both groups. Half respondents from both groups think infertility is a disease. In Jakarta 93.4% respondents consider both female and male should be investigated for infertility; in Sumba only 55.4% agree while 33.1% consider only female should be investigated. Infertility is an acceptable reason for polygamy for 41.3% respondents in Sumba, with 34.7% blaming maternal side for childlessness. Most respondents from both groups accept the use of Assisted Reproductive Technology and fertility enhancing drugs as treatment options. CONCLUSION: Lack of understanding, misleading myths, and negative attitude towards infertility have been illustrated in the sample population.


Assuntos
Atitude Frente a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Infertilidade/psicologia , Infertilidade/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Técnicas de Reprodução Assistida/psicologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Serviços de Planejamento Familiar , Feminino , Educação em Saúde , Humanos , Indonésia/epidemiologia , Infertilidade/epidemiologia , Masculino , Pessoa de Meia-Idade , População Rural , População Urbana , Adulto Jovem
5.
Blood ; 134(9): 746-760, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31292116

RESUMO

Patients with hematologic malignancies and those undergoing hematopoietic cell transplantation (HCT) face a complex set of challenges when considering options for fertility preservation (FP). There are no standard options for prepubertal children, and women with hematologic malignancies may not be eligible for standard FP options. Fortunately, initial therapies for most blood cancers are not highly gonadotoxic, affording an important opportunity for postremission counseling and referrals to fertility specialists. These patients face a high risk of relapse, and many will be referred for autologous or allogeneic HCT, which carries an extremely high risk of infertility. The expanding indications for HCT to include benign hematologic disorders as well as autoimmune diseases mandate that all hematologists are familiar with these risks. Oncofertility researchers are continually pushing the boundaries of what may be possible for our patients; in the meantime, communication and shared decision-making between hematologists and patients, as well as program-building, education, and outreach are essential to ensure that these patients, many of whom will be cured, maintain all of their options for a fulfilling life after intensive therapy.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Feminino , Neoplasias Hematológicas/complicações , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Infertilidade/etiologia , Infertilidade/terapia , Masculino , Qualidade de Vida
7.
J Assist Reprod Genet ; 36(8): 1665-1681, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31346936

RESUMO

PURPOSE: The market of assisted reproductive technologies (ARTs) is rapidly evolving, raising growing ethical and social dilemmas. This paper compares the regulatory responses to technological and market developments in Israel and Spain, both intensive users of ART. We identify strengths and deficiencies in the regulation of ART in these two countries. METHODS: We developed a conceptual framework to classify the factors affecting regulations and priority setting, and applied it using a Delphi survey combined with in-depth interviews. We selected two panels of experts from various fields, trying to simulate the bioethics committees of Israel and Spain. RESULTS: ART is often wrongfully perceived as a solution to age-related infertility. Both panels embraced alternative solutions. The impact of private commercial interest on regulations is resulting in excessive practices such as the repeat of ineffective cycles and the push of sometimes unnecessary treatment add-ons. Our findings show experts dissatisfaction with the regulations of donor-eggs concerning reimbursement and registries in both countries. CONCLUSIONS: The adequacy of ART to solve age-related infertility should be confronted with alternative approaches, with emphasis on the distribution of accurate information. The magnitude of ART markets, particularly the use of donor-eggs, should raise the need for additional societal debate and the reform of regulations. The impact factors analysis leads us to question the current regulatory framework, which could be improved by nominating a non-governmental statutory central regulatory agency in Israel and by reforming the Spanish agency.


Assuntos
Infertilidade/terapia , Sistema de Registros/estatística & dados numéricos , Técnicas de Reprodução Assistida/legislação & jurisprudência , Feminino , Humanos , Infertilidade/epidemiologia , Israel/epidemiologia , Gravidez , Resultado da Gravidez , Espanha/epidemiologia , Inquéritos e Questionários
8.
J Assist Reprod Genet ; 36(8): 1657-1664, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31338723

RESUMO

OBJECTIVE: High-density lipoproteins (HDL) exert pleiotropic roles in follicular fluid (FF). Previous studies have reported a relationship between obesity, infertility, and systemic oxidative stress. The aim of our study was to investigate for the first time the HDL functional properties in FF in obesity. METHODS: In this observational study, overweight/obese (n = 20) and normal-weight women (n = 38) undergoing assisted reproductive technology were included. Compositional properties and biochemical marker of functionality (HDL oxidation rate), HDL-associated antioxidants (paraoxonase-1 activities and CoQ10 content), and lipid hydroperoxide levels were evaluated in FF from normal-weight and overweight/obese women. Correlations between biochemical parameters and indices for oocyte and embryo quality were studied. RESULTS: FF-HDL obtained from overweight/obese women are characterized by high intrinsic ability to be oxidized compared with FF-HDL from normal-weight women. These alterations are associated with lower activities of paraoxonase-1 (PON1), higher levels of lipid peroxidation, and a lower total antioxidant capacity in FF. Moreover, an association between PON1 activity and FF-HDL oxidation and clinical parameter of oocyte quality was observed. CONCLUSION: Our data suggest that the quality of FF-HDL is important determinant for oocyte quality. Therefore, targeting FF-HDL functionality, in addition to FF-HDL-C levels, may represent a promising and interesting biomarker for reproductive outcomes.


Assuntos
Líquido Folicular/metabolismo , Infertilidade/metabolismo , Lipoproteínas HDL/metabolismo , Obesidade/metabolismo , Adulto , Arildialquilfosfatase/metabolismo , Índice de Massa Corporal , Feminino , Humanos , Infertilidade/terapia , Peroxidação de Lipídeos , Obesidade/fisiopatologia , Oxirredução , Estresse Oxidativo , Gravidez , Técnicas de Reprodução Assistida
9.
Cir. pediátr ; 32(3): 141-144, jul. 2019.
Artigo em Espanhol | IBECS | ID: ibc-183733

RESUMO

Objetivos: El varicocele constituye la principal causa de infertilidad masculina tratable. Su fisiopatología no es todavía bien conocida y existen varios estudios que sugieren que esta patología se desarrolla con menos frecuencia en pacientes obesos. Sin embargo, la relación entre el varicocele y el índice de masa corporal (IMC) continúa siendo controvertida. Nuestro objetivo es estudiar los pacientes pediátricos con varicocele y establecer una relación entre el IMC de estos pacientes y esta patología. Material y métodos: Para estudiar la relación entre el varicocele y el índice de masa corporal en la población infantil, revisamos a los pacientes intervenidos de varicocele en nuestro centro. Se estudiaron 79 pacientes en los últimos 10 años. Todos los pacientes fueron tratados con técnica de Palomo. Analizamos: edad, localización y grado de varicocele, peso y talla, técnica quirúrgica, aparición de hidrocele reactivo u otras complicaciones, recurrencia de varicocele y reintervención. Resultados: Observamos en nuestra serie una mayor frecuencia de varicocele en pacientes más altos y delgados (menor IMC) comparándolos con los pacientes con mayor masa corporal en relación a la altura. Conclusiones: Concluimos que según nuestra serie y en concordancia con literatura, el varicocele podría darse con más frecuencia en pacientes altos y delgados. Son necesarios más estudios para confirmar este hecho y aclarar la fisiopatología de esta entidad, pero dado que se trata de una patología que podría tener repercusión en la fertilidad creemos que debemos estar alerta en este grupo de pacientes para detectar esta patología y valorar la necesidad de corrección


Objectives: Varicocele is a dilatation of the venous pampiniform plexus considered the leading cause of correctible male infertility. Varicocele ethology remains controversial and there have been several studies which inform that varicoceles are found less frequently in obese adolescents but relationship between varicocele and body mass index (BMI) remains controversial yet. Subjects and methods: To study the relationship between varicocele and body mass index in children population we review the patients treated for varicocele in our institution. We analyzed patients with varicocele surgical correction in our centre in the last 10 years. At our institution all patients were treated by Palomo technique. We analyzed: age, location and degree of varicocele, weight and height, surgical technique, appearance of reactive hydrocele or others complications, varicocele recurrence and reoperation. Our objective is to study the relationship between BMI and varicocele in adolescent boys. Results: We observed that varicocele in our series was found more frequently in taller patients and less frequently in obese patients (higher BMI). Conclusions: Future studies will be needed to confirm that theory and to understand varicocele ethology but we consider that this fact is very useful because we are talking about a pathology with repercussion in fertility so we must be alert about it in adolescent population to correct it


Assuntos
Humanos , Adolescente , Varicocele/complicações , Índice de Massa Corporal , Antropometria , Recidiva , Varicocele/cirurgia , Complicações Pós-Operatórias , Infertilidade/complicações , Infertilidade/terapia
10.
Zygote ; 27(4): 219-224, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31250777

RESUMO

This is a retrospective study over a 5-year period. In total, 3139 embryos were individually cryopreserved (Cryotop®) and warmed using the Kitazato vitrification/warming kit. They were classified into three categories based on their expansion degree. Transfer, implantation and pregnancy rates were assessed for each embryo category and compared using SPSS (Statistical Package for the Social Sciences) software. In total, 1139 couples enrolled in infertility treatment programme benefitted from embryo vitrification at day 5. After warming, embryos belonging to the three categories showed similar success rates. Although there was a trend towards better outcomes when grade 3 embryos were transferred, the differences did not reach statistical significance: implantation rates (n fetal sac/n embryo transferred) grade 1: 21.9%, grade 2: 22.7% and grade 3: 30.3% (=0.19). Pregnancy rate (n clinical pregnancy/n transfer) (21.9%, 22.7%, 30.3%, respectively; P=0.11). Miscarriage rate was not statistically different in the three categories (14.5%, 20.4%, 20%, respectively, P=0.51). Our overall results show that it is worth vitrifying slow kinetics embryos as they provide a non-negligible chance to give rise to a pregnancy.


Assuntos
Blastocisto/fisiologia , Criopreservação/métodos , Implantação do Embrião/fisiologia , Transferência Embrionária/métodos , Embrião de Mamíferos/fisiologia , Adulto , Técnicas de Cultura Embrionária/métodos , Transferência Embrionária/estatística & dados numéricos , Feminino , Humanos , Infertilidade/terapia , Masculino , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Fatores de Tempo , Vitrificação
11.
Niger J Clin Pract ; 22(6): 806-811, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187766

RESUMO

Objective: Studies related to traditional practices and benefits have been usually performed among women. The literature regarding the traditional practices used by men in Turkey and around the world and their expected benefits is more limited. The aim of this study was to examine the traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths. Materials and Methods: The descriptive study was performed between May and July 2017 in Izmir, Turkey. In total, 151 women with infertility were included. The data related to the use of this practice by men were obtained from women partners. "Personal information form" and "traditional practices evaluation form" were used to obtain the data. Results: In total, 35.8% of the women and 25.8% of the men used traditional practices. The 24.4% of women and 52.1% of men used other practices such as figs, onion cures, and hacamat, whereas 18.2% of women and 14.9% of men used various herbs. The benefits they expected from traditional practices were facilitating conception, ensuring follicle development in women, increasing sperm count, and quality and facilitating conception in men. Overall, 37.0% of women learned of these practices from their friends, 30.7% of men learned from their partners, 20.4% of women and 20.6% of men learned from the internet. Conclusion: The couples in this study widely used traditional practices to solve fertility problems and learned from their friends and partners.


Assuntos
Terapias Complementares , Fertilidade , Infertilidade/terapia , Fitoterapia , Autocuidado/métodos , Adulto , Feminino , Amigos , Humanos , Comportamento de Busca de Informação , Internet , Masculino , Medicina Tradicional , Preparações de Plantas/uso terapêutico , Análise do Sêmen , Cônjuges , Turquia
12.
Best Pract Res Clin Endocrinol Metab ; 33(1): 89-102, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31208678

RESUMO

While still considered an experimental procedure in most countries, ovarian tissue cryopreservation and transplantation has been increasingly applied worldwide to restore fertility in patients with malignant and non-malignant pathologies with risk of premature ovarian insufficiency. It has yielded more than 130 live births up to now and almost all transplanted patients recovered their ovarian function. This study summarizes ovarian tissue cryopreservation and transplantation indications, procedures, their efficacy and main results and proposes different strategies to improve this strategy. Although the main focus of this study is on ovarian tissue cryopreservation and transplantation as a strategy to restore fertility, we believe that it is also important to discuss other applications for this approach.


Assuntos
Criopreservação , Preservação da Fertilidade/métodos , Infertilidade/terapia , Ovário , Criopreservação/métodos , Feminino , Humanos , Ovário/transplante , Gravidez , Insuficiência Ovariana Primária/terapia , Reoperação , Transplante Autólogo
13.
Int J Mol Sci ; 20(12)2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31207900

RESUMO

Small noncoding RNAs (sncRNAs) are key regulators of the majority of human reproduction events. Understanding their function in the context of gametogenesis and embryogenesis will allow insight into the possible causes of in vitro fertilization (IVF) implantation failure. The aim of this study was to analyze the sncRNA expression profile of the spent culture media on day 4 after fertilization and to reveal a relationship with the morphofunctional characteristics of gametes and resultant embryos, in particular, with the embryo development and implantation potential. Thereto, cell-free, embryo-specific sncRNAs were identified by next generation sequencing (NGS) and quantified by reverse transcription coupled with polymerase chain reaction (RT-PCR) in real-time. Significant differences in the expression level of let-7b-5p, let-7i-5p, piR020401, piR16735, piR19675, piR20326, and piR17716 were revealed between embryo groups of various morphological gradings. Statistically significant correlations were found between the expression profiles of piR16735 and piR020401 with the oocyte-cumulus complex number, let-7b-5p and piR020401 with metaphase II oocyte and two pronuclei embryo numbers, let-7i-5p and piR20497 with the spermatozoid count per milliliter of ejaculate, piR19675 with the percentage of linearly motile spermatozoids, let-7b-5p with the embryo development grade, and let-7i-5p with embryo implantation. According to partial least squares discriminant analysis (PLS-DA), the expression levels of let-7i-5p (Variable Importance in Projection score (VIP) = 1.6262), piR020401 (VIP = 1.45281), and piR20497 (VIP = 1.42765) have the strongest influences on the implantation outcome.


Assuntos
Blastocisto/metabolismo , Fertilização In Vitro/estatística & dados numéricos , Infertilidade/genética , Pequeno RNA não Traduzido/genética , Adulto , Biomarcadores/análise , Biomarcadores/metabolismo , Meios de Cultura/química , Feminino , Humanos , Infertilidade/metabolismo , Infertilidade/terapia , Masculino , Oócitos/metabolismo , Pequeno RNA não Traduzido/análise , Pequeno RNA não Traduzido/metabolismo
15.
Eur J Obstet Gynecol Reprod Biol ; 240: 99-102, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31238206

RESUMO

OBJECTIVE: To investigate the effect of different TSH (0.5-2.49 mIU/L and 2.5-4.5 mIU/L) levels on intrauterine insemination (IUI) outcomes of euthyroid unexplained subfertile patients who are negative for thyroid antibodies. STUDY DESIGN: In this retrospective cohort study, data of euthyroid subfertile patients who underwent IUI due to unexplained infertility at a university-based infertility clinic between January 2013 and December 2014 were reviewed. A total of 156 patients of them were categorized into two groups according to pre-conceptional TSH levels. The first study group consisted of patients with serum TSH levels 0.5-2.49 mIU/L and the second study group consisted of patients with serum TSH levels 2.5-4.5 mIU/L. The primary outcome measure was live birth rate. RESULTS: Demographics and cycle characteristics of the study groups were similar. There were no statistically significant differences between the study groups regarding main outcome measures (live birth rate, P = 0.82; clinical pregnancy rate, P = 0.64; miscarriage rate, P = 0.57). CONCLUSION: Pre-conceptional TSH levels ranging between 0.5-4.5 mU/L does not appear to have a significant effect on IUI outcome of euthyroid women who are negative for thyroid antibodies.


Assuntos
Fertilização In Vitro , Infertilidade/terapia , Inseminação Artificial/métodos , Tireotropina/sangue , Adulto , Feminino , Humanos , Infertilidade/sangue , Masculino , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
J Assist Reprod Genet ; 36(6): 1081-1090, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31104290

RESUMO

PURPOSE: How can elective egg freezing (EEF) be made patient centered? This study asked women to reflect on their experiences of EEF, which included their insights and recommendations on the optimal delivery of patient-centered care. METHODS: In this binational, qualitative study, 150 women (114 in the USA, 36 in Israel) who had completed at least one cycle of EEF were recruited from four American IVF clinics (two academic, two private) and three in Israel (one academic, two private) over a two-year period (June 2014-August 2016). Women who volunteered for the study were interviewed by two medical anthropologists. Interviews were audio recorded, transcribed, and entered into a qualitative data management program (Dedoose) for analysis. RESULTS: The majority (85%) of women were without partners at the time of EEF, and thus were undertaking EEF alone in mostly couples-oriented IVF clinics. Following the conceptual framework known as "patient-centered infertility care," we identified two broad categories and eleven specific dimensions of patient-centered EEF care, including (1) system factors: information, competence of clinic and staff, coordination and integration, accessibility, physical comfort, continuity and transition, and cost and (2) human factors: attitude and relationship with staff, communication, patient involvement and privacy, and emotional support. Cost was a unique factor of importance in both countries, despite their different healthcare delivery systems. CONCLUSIONS: Single women who are pursuing EEF alone in the mostly couples-oriented world of IVF have distinct and multifaceted needs. IVF clinics should strive to make best practices for patient-centered EEF care a high priority.


Assuntos
Preservação da Fertilidade/psicologia , Infertilidade/terapia , Óvulo/fisiologia , Assistência Centrada no Paciente , Adulto , Criopreservação , Feminino , Humanos , Infertilidade/epidemiologia , Infertilidade/fisiopatologia , Infertilidade/psicologia , Qualidade da Assistência à Saúde , Estados Unidos/epidemiologia
17.
J Pak Med Assoc ; 69(5): 640-646, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105282

RESUMO

OBJECTIVE: To investigate the role of paternal obesity on intracytoplasmic sperm injection success. METHODS: The retrospective study was conducted in Suleyman Demirel University, Isparta, Turkey, from January 2015 to September 2017, and comprised data of infertile couples having undergone intracytoplasmic sperm injection cycle. The data was divided into three groups on the basis of paternal body mass index (BMI): normoweight NW (body mass index<23 kg/m2), overweight OW (body mass index= 23-24.9 kg/m2), and obese group (body mass index ≥25 kg/m2). Fertilisation rate, count and quality of embryos, implantation, clinical pregnancy, take-home baby, abortion rates and sperm parameters were evaluated. SPSS 20 was used for data analysis. RESULTS: Of the 374 cases, 45(12%) were in NW group, 78(21%) in OW, and 251(67%) in obese group. The overall mean age of males was 34.60}5.80 years, and mean body mass index was 26.84}3.57 kg/m2. There were no statistically significant differences in terms of fertilization rate, embryo count and quality, implantation, clinical pregnancy, take-home baby and abortion rates among the groups (p>0.05). Paternal obesity was not associated with sperm count and motility (p>0.05) either. Regression analysis showed that paternal obesity had no predictive effect on intracytoplasmic sperm injection success (p>0.05). CONCLUSIONS: Excess weight in male partner had no effect on intracytoplasmic sperm injection success.


Assuntos
Aborto Espontâneo/epidemiologia , Implantação do Embrião , Pai , Infertilidade/terapia , Nascimento Vivo/epidemiologia , Obesidade/epidemiologia , Injeções de Esperma Intracitoplásmicas , Adulto , Índice de Massa Corporal , Feminino , Fertilização In Vitro , Humanos , Masculino , Sobrepeso/epidemiologia , Gravidez , Prognóstico , Estudos Retrospectivos , Contagem de Espermatozoides , Motilidade Espermática , Centros de Atenção Terciária , Resultado do Tratamento , Turquia
18.
J Med Life ; 12(1): 56-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31123526

RESUMO

Reproductive health is vital for human and infertility is also one of the most important challenges in the reproductive system. Infertility is one of the most common chronic health disorders, regardless of age. The Minimum Data Set (MDS) helps to manage infertility by monitoring and evaluating infertility interventions based on collecting data. The development of MDS is an essential objective in order to implement an infertility monitoring system for the creation of standardized and effective data management through the provision of comprehensive and identical data elements for infertility. This is a descriptive cross-sectional study conducted in 2017. The data has been collected from infertility clinics in the world, as well as WHO, CDC, ASRM, and ESHRE reports. In order to decide on data elements, the Delphi technique was used using a questionnaire that contained data elements which were distributed among 12 experts including one reproductive endocrinology and infertility fellow, six obstetrician-gynecologists, two reproductive biologists, two urologists and one community medicine specialist using the 5 point Likert scale. The questionnaire was divided into two categories: managerial and clinical, each with 4 sections, and 60 and 940 data elements, respectively. MDS is an essential tool for evaluating the infertility process. Using this tool will provide an opportunity to develop a set of quality care criteria that can be used to ensure the quality of infertility care.


Assuntos
Análise de Dados , Infertilidade/diagnóstico , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Infertilidade/terapia , Masculino , Inquéritos e Questionários
19.
Reprod Health ; 16(1): 47, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053144

RESUMO

BACKGROUND: Health state utility values allow for comparison of treatments across different diseases. Utility values for fertility-impaired health states are currently unavailable. Such values are necessary in order to determine the relative costs-effectiveness of fertility treatments. METHODS: This study aimed to determine utility weights for infertile and subfertile health states. In addition, it explored the Dutch general population's opinions regarding the inclusion of infertility treatments in the Dutch health insurers' basic benefit package. An online questionnaire was designed to determine the health-related quality of life values of six fertility-impaired health states. The study population consisted of a representative sample of the Dutch adult population. Respondents were asked to evaluate the health states through direct health valuation methods, i.e. the Visual Analogue Scale (VAS) and the Time Trade-Off (TTO) method. In addition, respondents were asked about their opinions regarding reimbursement of fertility-related treatments. RESULTS: The respondents' (n = 767) VAS scores ranged from 0.640 to 0.796. TTO utility values ranged from 0.792 to 0.868. Primary infertility and subfertility was valued lower than secondary infertility and subfertility. In total, 92% of the respondents stated that fertility treatments should be fully or partially reimbursed by the health insurance basic benefit package. CONCLUSIONS: Having fertility problems results in substantial disutilities according to the viewpoint of the Dutch general population. The results make it possible to compare the value for money of infertility treatment to that of treatments in other disease areas. There is strong support among the general population for reimbursing fertility treatments through the Dutch basic benefit package.


Assuntos
Infertilidade/terapia , Seguro Saúde , Medicina Estatal , Feminino , Humanos , Infertilidade/economia , Infertilidade/psicologia , Masculino , Países Baixos
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