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1.
Obstet Gynecol Clin North Am ; 48(4): 801-812, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34756298

RESUMO

Treatment of infertility has evolved as understanding of reproduction has improved. Fertility promoting surgery still is performed and recent advances have broken new ground. Hormonal treatments to correct gonadal dysfunction have been developed, but multiple gestation continues to be a significant complication. Assisted reproductive technologies have improved such that in vitro fertilization and its variants increasingly are used to treat nearly all causes of infertility. Advances in assisted reproduction are of 2 types: (1) incremental optimization of existing techniques and (2) development of new, disruptive technologies. Artificial intelligence and stem cell technologies are poised to have impact in the near future.


Assuntos
Inteligência Artificial , Infertilidade , Feminino , Fertilização In Vitro , Humanos , Infertilidade/terapia , Gravidez , Gravidez Múltipla , Técnicas de Reprodução Assistida
2.
Int J Mol Sci ; 22(19)2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34639209

RESUMO

The process of freezing cells or tissues and depositing them in liquid nitrogen at -196 °C is called cryopreservation. Sub-zero temperature is not a physiological condition for cells and water ice crystals represent the main problem since they induce cell death, principally in large cells like oocytes, which have a meiotic spindle that degenerates during this process. Significantly, cryopreservation represents an option for fertility preservation in patients who develop gonadal failure for any condition and those who want to freeze their germ cells for later use. The possibility of freezing sperm, oocytes, and embryos has been available for a long time, and in 1983 the first birth with thawed oocytes was achieved. From the mid-2000s forward, the use of egg vitrification through intracytoplasmic sperm injection has improved pregnancy rates. Births using assisted reproductive technologies (ART) have some adverse conditions and events. These risks could be associated with ART procedures or related to infertility. Cryopreservation generates changes in the epigenome of gametes and embryos, given that ART occurs when the epigenome is most vulnerable. Furthermore, cryoprotective agents induce alterations in the integrity of germ cells and embryos. Notably, cryopreservation extensively affects cell viability, generates proteomic profile changes, compromises crucial cellular functions, and alters sperm motility. This technique has been widely employed since the 1980s and there is a lack of knowledge about molecular changes. The emerging view is that molecular changes are associated with cryopreservation, affecting metabolism, cytoarchitecture, calcium homeostasis, epigenetic state, and cell survival, which compromise the fertilization in ART.


Assuntos
Cálcio/metabolismo , Criopreservação/normas , Embrião de Mamíferos/citologia , Epigênese Genética , Células Germinativas/citologia , Infertilidade/terapia , Proteoma/metabolismo , Sobrevivência Celular , Crioprotetores/química , Feminino , Preservação da Fertilidade/normas , Fertilização In Vitro , Células Germinativas/metabolismo , Humanos , Infertilidade/metabolismo , Infertilidade/patologia , Masculino , Oócitos/citologia , Oócitos/metabolismo , Gravidez , Espermatozoides/citologia , Espermatozoides/metabolismo
3.
BMC Med Res Methodol ; 21(1): 188, 2021 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544388

RESUMO

BACKGROUND: Patient-centered care is an essential component of health care quality. To achieve patient-centered care, health care authorities should have a clear definition and an applicable tool to measure the extent of its application. The real concept of patient centeredness should be developed by the patients themselves. We aimed to demonstrate a way to develop a draft Arabic patient-centered infertility care (PCIC) questionnaire for females clients following practical steps that address women with infertility. METHODS: An iterative process of questionnaire development was undertaken by combining two approaches: the steps proposed by Robert F. DeVellis for scale development and the recommended practices for questionnaire development and testing in the European statistical system. We attempted to develop the draft questionnaire that involved conceptualization and operationalization, generation of an item pool, development of the questionnaire format, review of the initial item pool by experts, and consideration of validation items for inclusion. RESULTS: We generated an item pool from in-depth interviews with 14 women who sought infertility care within 6 months before the interview time. We then added more items from a literature review. The item pool contained 123 items distributed through 10 domains. Ten women with infertility were included for face validation. Then, experts with backgrounds in Obstetrics and Gynecology, Family Medicine, and Public Health reviewed the item pool using content validation (n = 10 professors and/or specialists). The item pool was finally reduced to 57 items. We developed the draft Arabic patient-centered infertility care questionnaire for female clients (PCIQ-F) with three sections, including 66 items: background variables, PCIC experience variables, and a general question about the quality of infertility care in the health facility. The draft questionnaire was further reviewed and edited last by experts in preparation for part 2, which will test the questionnaire and prepare the final version. CONCLUSION: The PCIQ-F questionnaire development is a multi-step iterative process started and ended by the target users as experts. Experts' participation in infertility care and in questionnaire format development had a great impact on questionnaire development and conflict resolution. We recommend this transparent and replicable approach for new instrument developers; it is likely to generate a questionnaire that is valid and acceptable to target users. The draft PCIQ-F questionnaire is ready for testing of its psychometric properties before the final version to measure the PCIC level in health facilities.


Assuntos
Infertilidade , Assistência Centrada no Paciente , Feminino , Humanos , Infertilidade/diagnóstico , Infertilidade/terapia , Gravidez , Psicometria , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes , Inquéritos e Questionários
4.
Eur J Obstet Gynecol Reprod Biol ; 264: 241-246, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34340094

RESUMO

OBJECTIVE: To examine the magnitude and the predictors of emotional reactions to an infertility diagnosis, comparing women and men who were clinically diagnosed with an anatomical cause of infertility or non-anatomical cause of infertility. STUDY DESIGN: Cross-sectional study involving a total of 133 adults waiting for infertility treatment at the IVF and Infertility Unit of the S. Orsola University Hospital in Bologna (Italy). Of these, 107 patients (55 with anatomical causes of infertility and 52 with non-anatomical causes of infertility; response rate: 80%) took part to the study. After providing informed written consent, each participant was asked to complete the Infertility Self-efficacy Scale, the Fertility Quality of Life, and the Brief Coping Orientation to Problem Experienced, which they returned at their second access to the Unit. Differences between the groups were analyzed through a series of univariate ANOVA, whereas a multiple regression analysis was used to jointly examine the predictors of fertility quality of life. RESULTS: Results showed both gender related and diagnosis related differences. Women had statistically significant lower scores than men on the Infertility Self-Efficacy Scale and on the global, emotional, and mind-body subscales of the Fertility Quality of Life, while they scored significantly higher on the emotion focused and socially supported subscales of the Coping Orientation to Problem Experienced. Independently of gender, patients with non-anatomical causes of infertility scored poorly than patients with anatomical causes of infertility on the relational subscale of the Fertility Quality of Life and on the Avoidant scale of the Brief Coping Orientation to Problem Experienced. Hierarchical multiple regression analyses revealed that higher levels of self-efficacy and a lower use of avoidant coping strategies predicted a more positive quality of life over and above gender and cause of infertility. CONCLUSION: This study partly confirms data on gender differences in experiencing the psychological burden of infertility and adds some new information, particularly with respect to the prediction of quality of life indicators over and above infertility cause.


Assuntos
Infertilidade , Qualidade de Vida , Adaptação Psicológica , Adulto , Estudos Transversais , Feminino , Humanos , Infertilidade/terapia , Masculino , Técnicas de Reprodução Assistida , Autoeficácia , Estresse Psicológico , Inquéritos e Questionários
5.
Acta Obstet Gynecol Scand ; 100(10): 1858-1867, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34405396

RESUMO

INTRODUCTION: To study whether paternal age exerts an effect, independent of maternal age, on the outcomes of fresh in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles. Semen quality deteriorates with increasing paternal age; however, there is conflicting evidence for any impact paternal age may have on the outcome of IVF/ICSI. Several retrospective and prospective cohort studies have shown that paternal age increases the miscarriage rate and reduces the live birth rate. Some studies have shown no effect of paternal age on live birth rate or miscarriage rate. Studies involving donor oocytes have tended to show no independent effect of paternal age on assisted reproductive technology (ART) outcomes. The age at which paternal age may exert a significant deleterious effect on outcome is not known and there is no limit to paternal age in IVF/ICSI treatment. MATERIAL AND METHODS: A single-center retrospective cohort study was carried out at the Centre for Reproductive and Genetic Health, London, UK. Included in the analysis were all couples with primary or secondary infertility undergoing IVF/ICSI cycles in which the male partner produced a fresh semen sample and the cycle proceeded to fresh embryo transfer. All cycles of IVF/ICSI that used donor oocytes-donor sperm, frozen sperm, cycles leading to embryo storage and cycles including preimplantation genetic testing (PGT-A/PGT-M)-were excluded from analysis. The primary outcome was live birth rate and secondary outcomes were clinical pregnancy rate and miscarriage rate. Multivariate logistic regression analysis with live birth as a dependent variable and maternal and paternal age class as independent variables was performed. RESULTS: During the study period there were 4833 cycles, involving 4271 men, eligible for analysis; 1974/4833 (40.8%, 95% confiene intervals [CI] 39.5-42.2%) cycles resulted in a live birth. A significantly lower proportion of men over 51 years met World Health Organization semen analysis criteria (56/133, [42.1%, 95% CI 34.1-50.6]) compared with men under 51 years of age (2530/4138 [61.1%, 95% CI 60.0-62.6]) (p = 0.001). Both maternal and paternal age were retained in the multivariate model and for all maternal age subgroups the probability of live birth decreased with paternal age over 50 years (odds ratio [OR] 0.674, 95% CI 0.482-0.943) (p = 0.021). Paternal age over 50 years was not an independent predictor of miscarriage (OR 0.678, 95% CI 0.369-1.250) (p = 0.214). CONCLUSIONS: Paternal age over 50 significantly affects the chance of achieving a live birth following ART. Paternal age does not independently affect the risk of miscarriage following ART. There should be a public health message for men not to delay fatherhood.


Assuntos
Infertilidade/terapia , Idade Paterna , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Técnicas de Reprodução Assistida , Estudos Retrospectivos , Análise do Sêmen , Reino Unido
6.
Sci Rep ; 11(1): 16529, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400730

RESUMO

At the beginning of 2020, the Italian Lombardy region was hit by an "epidemic tsunami" which was, at that point in time, one of the worst pandemics ever. At that moment the effects of SARS-COV 2 were still unknown. To evaluate whether the pandemic has influenced ART (Assisted Reproduction Techniques) outcomes in an asymptomatic infertile population treated at one of the major COVID-19 epicentres during the weeks immediately preceding lockdown. All ART procedures performed during two time periods were compared: November 1st, 2018 to February 28th, 2019 (non-COVID-19 risk) and November 1st, 2019 to February 29th, 2020 (COVID-19 risk). In total 1749 fresh cycles (883 non-COVID-19 risk and 866 COVID-19 risk) and1166 embryos and 63 oocytes warming cycles (538 and 37 during non-COVID and 628 and 26 during COVID-19 risk, respectively) were analysed. Clinical pregnancies per cycle were not different: 370 (25.38%) in non-COVID versus 415 (27.30%) (p = 0.237) during COVID-19 risk. There were no differences in biochemical pregnancy rates 52 (3.57%) versus 38 (2.50%) (p = 0.089) nor in ectopic pregnancies 4 (1.08%) versus 3 (0.72%) (p = 0.594), spontaneous miscarriages 84 (22.70%) versus 103 (24.82%) p = 0.487, nor in intrauterine ongoing pregnancies 282 (76.22%) versus 309 (74.46%) p = 0.569. A multivariate analysis investigating differences in spontaneous miscarriage rate showed no differences between the two timeframes. Our results support no differences in asymptomatic infertile couples' ART outcomes between the pre COVID and COVID-19 periods in one of the earliest and most severe pandemic areas.


Assuntos
Aborto Espontâneo/epidemiologia , COVID-19/complicações , Infertilidade/terapia , Taxa de Gravidez , Técnicas de Reprodução Assistida/estatística & dados numéricos , Adulto , Infecções Assintomáticas/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/normas , Feminino , Humanos , Itália/epidemiologia , Masculino , Pandemias , Gravidez , Primeiro Trimestre da Gravidez , Técnicas de Reprodução Assistida/normas , Estudos Retrospectivos , Resultado do Tratamento
7.
Fertil Steril ; 116(2): 279-280, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353569

RESUMO

The goal of this Views and Reviews is to let colleagues and leaders well versed in the African American experience in reproductive medicine address the problems of racism affecting our trainees and patients and, more significantly, propose solutions. The areas in reproductive medicine that will be explored from the African American perspective include the pipeline of providers, health disparities, and access to infertility treatment.


Assuntos
Afro-Americanos , Disparidades em Assistência à Saúde , Racismo , Medicina Reprodutiva , Afro-Americanos/etnologia , Afro-Americanos/história , Educação de Pós-Graduação em Medicina/ética , Educação de Pós-Graduação em Medicina/história , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/tendências , Escravização/ética , Escravização/história , Feminino , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/história , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Infertilidade/etnologia , Infertilidade/história , Infertilidade/terapia , Masculino , Relações Médico-Paciente/ética , Racismo/ética , Racismo/história , Racismo/prevenção & controle , Medicina Reprodutiva/educação , Medicina Reprodutiva/ética , Medicina Reprodutiva/história , Medicina Reprodutiva/tendências , Fatores Socioeconômicos
8.
Psychiatriki ; 32(3): 232-240, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34390557

RESUMO

This systematic review aimed to investigate the inconsistency of research data concerning the contribution of systematic psychosocial interventions to infertility treatments. More specifically, the objective of this review was to investigate the cause of the contradictions in the results of contemporary research with respect to the role of systematic psychosocial interventions in the success of fertility treatments. The suspected cause of these contradictions is the heterogeneity of the relevant clinical studies with respect to their methodology. Thus, the specific aim of the current review was to evaluate the degree of heterogeneity of certain parameters in the design of the relevant clinical studies during the last decade, including sample heterogeneity, assisted reproductive technology methods, types of psychosocial interventions and methods of recording and analyzing psychometric data. This investigation may be considered imperative considering that despite the great number of relevant clinical studies and their meta-analyses, there are still no conclusive results concerning the potential of improving fertility through psychosocial support. Search for relevant studies was performed employing the PubMed and Google Scholar databases based on specific criteria. According to these criteria the selected publications have been meta-analyses of clinical studies on humans, evaluating the effect of psychosocial interventions on the success of assisted reproductive treatments during the last decade. The studies may have included all the different infertility etiologies, as well as all types of assisted reproductive treatments. The extensive search based on the specific inclusion/exclusion criteria resulted in reporting results from 6 studies in total. The clinical studies included have reported on various types of interventions for psychosocial support such as individual, couples' or group therapies performed either in facilities offering mental health services or in the form of home-based self-treatment. Moreover, these studies investigated various techniques of stress management ranging from counseling to specialized methods such as biofeedback and diaphragmatic breathing or alternative techniques such as yoga and meditation. Our results suggest that clinical studies designed specifically to evaluate the effect of systematic interventions on the efficacy of fertility treatments are limited. Moreover, their degree of heterogeneity is highly significant with respect to included participants, treatment protocols, psychosocial support techniques as well as methods for the documentation and statistical analysis of psychometric data. Consequently, the conduction of well-design clinical studies based on strict criteria aiming to investigate specific infertility causes, similar fertility treatment protocols or particular types of psychosocial interventions is necessary in order to reach definitive conclusions.


Assuntos
Infertilidade , Intervenção Psicossocial , Aconselhamento , Humanos , Infertilidade/terapia , Psicoterapia , Técnicas de Reprodução Assistida
10.
Cells ; 10(8)2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34440657

RESUMO

Assisted reproductive technologies (ARTs) have developed considerably in recent years; however, they cannot rectify germ cell aplasia, such as non-obstructive azoospermia (NOA) and oocyte maturation failure syndrome. In vitro gametogenesis is a promising technology to overcome infertility, particularly germ cell aplasia. Early germ cells, such as primordial germ cells, can be relatively easily derived from pluripotent stem cells (PSCs); however, further progression to post-meiotic germ cells usually requires a gonadal niche and signals from gonadal somatic cells. Here, we review the recent advances in in vitro male and female germ cell derivation from PSCs and discuss how this technique is used to understand the biological mechanism of gamete development and gain insight into its application in infertility.


Assuntos
Gametogênese , Células Germinativas/fisiologia , Células-Tronco Pluripotentes/fisiologia , Animais , Células Cultivadas , Feminino , Fertilidade , Humanos , Infertilidade/fisiopatologia , Infertilidade/terapia , Masculino , Oogênese , Óvulo/fisiologia , Técnicas de Reprodução Assistida , Espermatogênese , Espermatogônias/fisiologia
11.
Am J Physiol Regul Integr Comp Physiol ; 321(3): R454-R468, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34346723

RESUMO

We evaluated maternal pregnancy adaptations and their relationships with circulating hormones in women who conceived with or without in vitro fertilization (IVF). Pregnancies were grouped by corpus luteum (CL) number: 1 CL with physiological plasma relaxin concentration (PRLN; spontaneous pregnancies); 0 CL without circulating RLN (programmed cycles); >1 CL with elevated PRLN (ovarian stimulation). Major findings were that declines in plasma osmolality (Posm) and plasma sodium concentration ([Formula: see text]) were comparable in the 1 CL and 0 CL cohorts, correlated with plasma estradiol and progesterone concentrations but not PRLN; gestational declines in plasma uric acid (UA) concentration (PUA) were attenuated after IVF, especially programmed cycles, partly because of subdued increases of renal UA clearance; and PRLN and cardiac output (CO) were inversely correlated when plasma estradiol concentration was below ∼2.5 ng/mL but positively correlated above ∼2.5 ng/mL. Unexpectedly, PRLN and plasma sFLT1 (PsFLT1) were directly correlated. Although PsFLT1 and CO were not significantly associated, CO was positively correlated with plasma placental growth factor (PLGF) concentration after the first trimester, particularly in women who conceived with 0 CL. Major conclusions are that 1) circulating RLN was unnecessary for gestational falls in Posm and [Formula: see text]; 2) PRLN and CO were inversely correlated during early gestation, suggesting that PRLN in the lower range may have contributed to systemic vasodilation, whereas at higher PRLN RLN influence became self-limiting; 3) evidence for cooperativity between RLN and estradiol on gestational changes in CO was observed; and 4) after the first trimester in women who conceived without a CL, plasma PLGF concentration was associated with recovery of CO, which was impaired during the first trimester in this cohort.


Assuntos
Fertilização In Vitro , Hormônios Gonadais/sangue , Hemodinâmica , Infertilidade/terapia , Adaptação Fisiológica , Adulto , Biomarcadores/sangue , Débito Cardíaco , Estradiol/sangue , Feminino , Humanos , Infertilidade/sangue , Infertilidade/fisiopatologia , Pessoa de Meia-Idade , Concentração Osmolar , Fator de Crescimento Placentário/sangue , Gravidez , Primeiro Trimestre da Gravidez/sangue , Relaxina/sangue , Sódio/sangue , Ácido Úrico/sangue , Vasodilatação , Adulto Jovem
13.
Reprod Biomed Online ; 43(4): 747-755, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34404622

RESUMO

RESEARCH QUESTION: How do infertility patients, endometriosis patients and health-care providers rate virtual care as an alternative to physical consultations during the first lockdown of the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands, and how does this influence quality of life and quality of care? DESIGN: Infertility patients and endometriosis patients from a university hospital and members of national patient organizations, as well as healthcare providers in infertility and endometriosis care, were asked to participate between May and October 2020. The distributed online questionnaires consisted of an appraisal of virtual care and an assessment of fertility-related quality of life (FertiQol) and patient-centredness of endometriosis care (ENDOCARE). RESULTS: Questionnaires were returned by 330 infertility patients, 181 endometriosis patients and 101 healthcare providers. Of these, 75.9% of infertility patients, 64.8% of endometriosis patients and 80% of healthcare providers rated telephone consultations as a good alternative to physical consultations during the COVID-19-pandemic. Only 21.3%, 14.8% and 19.2% of the three groups rated telephone consultations as a good replacement for physical consultations in the future. A total of 76.6% and 35.9% of the infertility and endometriosis patients reported increased levels of stress during the pandemic. Infertility patients scored lower on the FertiQol, while the ENDOCARE results care seem comparable to the reference population. CONCLUSIONS: Virtual care seems to be a good alternative for infertility and endometriosis patients in circumstances where physical consultations are not possible. Self-reported stress is especially high in infertility patients during the COVID-19-pandemic. Healthcare providers should aim to improve their patients' ability to cope.


Assuntos
COVID-19/epidemiologia , Endometriose/terapia , Infertilidade/terapia , Adulto , Estudos Transversais , Endometriose/psicologia , Feminino , Hospitais Universitários , Humanos , Infertilidade/psicologia , Países Baixos/epidemiologia , Assistência Centrada no Paciente , Qualidade da Assistência à Saúde , Qualidade de Vida , Estresse Psicológico , Inquéritos e Questionários , Telemedicina
14.
Fertil Steril ; 116(4): 990-1000, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34373103

RESUMO

OBJECTIVE: To investigate whether preimplantation genetic testing (PGT) increases the risk of adverse obstetric and neonatal outcomes. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Pregnancies achieved after PGT or in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). INTERVENTION(S): Systematic search of databases until December 2020 with cross-checking of references from relevant articles in English. MAIN OUTCOME MEASURE(S): Obstetric and neonatal outcomes after PGT and IVF/ICSI, including mean birth weight, low birth weight, very low birth weight (VLBW), mean gestational age at birth, preterm birth, very preterm birth, birth defects, intrauterine growth retardation (IUGR), sex ratio, cesarean section, hypertensive disorders of pregnancy, gestational diabetes mellitus, placenta disorder (placenta previa, placenta abruption, placenta accreta), and preterm premature rupture of membranes. RESULT(S): Ultimately, a total of 785,445 participants were enrolled in this meta-analysis, and these participants were divided into a PGT group (n = 54,294) and an IVF/ICSI group (n = 731,151). The PGT pregnancies had lower rates of low birth weight (risk ratio [RR] 0.85, 95% confidence interval [CI] 0.75 to 0.98), VLBW (RR 0.52, 95% CI 0.33 to 0.81), and very preterm births (RR 0.55, 95% CI 0.42 to 0.70) than those of IVF/ICSI pregnancies. However, the PGT group had a higher rate of the obstetric outcome of hypertensive disorders of pregnancy (RR 1.30, 95% CI 1.08 to 1.57). The PGT did not increase the risk of other adverse obstetric and neonatal outcomes, such as those associated with mean birth weight, mean gestational age at birth, birth defects, IUGR, sex ratio, cesarean section, gestational diabetes mellitus, placental disorder (placenta previa, placenta abruption, placenta accreta), or preterm premature rupture of membranes. We performed subgroup analysis with only blastocyst biopsies and found that PGT with blastocyst biopsies was associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.95). The PGT with blastocyst biopsies did not increase the risk of other adverse obstetric and neonatal outcomes. Additionally, we performed subgroup analysis with only frozen-thawed embryo transfer cycles, and we found that PGT pregnancies were associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.97), a lower rate of cesarean birth (RR 0.90, 95% CI 0.82 to 0.99), a higher rate of preterm birth (RR 1.10, 95% CI 1.02 to 1.18), and a higher rate of IUGR (RR 1.21, 95% CI 1.06 to 1.38) than those of IVF/ICSI pregnancies. The PGT with frozen-thawed embryo transfer did not increase the risk of other adverse obstetric and neonatal outcomes. CONCLUSION(S): The pooled analysis suggested that PGT did not increase the risk of adverse obstetric outcomes. The association between PGT and a higher risk of IUGR requires further investigation.


Assuntos
Fertilização In Vitro , Testes Genéticos , Infertilidade/terapia , Diagnóstico Pré-Implantação , Peso ao Nascer , Feminino , Fertilização In Vitro/efeitos adversos , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Masculino , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez/etiologia , Diagnóstico Pré-Implantação/efeitos adversos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
15.
West Afr J Med ; 38(7): 679-683, 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34331424

RESUMO

Assisted reproductive technology (ART) is becoming a popular method of treating infertility in Nigeria however the practice still remains largely unregulated leaving room for unethical practices and/or with possible financial exploitation of the infertile couple thereby compounding their misery. There is an urgent need for widespread adoption of proper ethical guidelines and regulation in the provision of ART services in the country for the protection of both the providers and the clients.


Assuntos
Infertilidade , Técnicas de Reprodução Assistida , Humanos , Infertilidade/terapia , Nigéria
16.
Fertil Steril ; 116(2): 287-291, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34253327

RESUMO

The first paper describing an association between African American race, infertility prevalence, and outcomes of fertility treatments was published more than 20 years ago, calling initial attention to differences in how infertility is experienced, diagnosed, and managed in African Americans. Since that initial publication, multiple other studies have explored African American race and its association with elements of the fertility spectrum-disparities that have been durable over time. The goal of this review is to provide an overview of the evolution of aspects of this research focusing on the outcomes of infertility treatments and barriers to access. A consideration of the system-based practice issues that interface with timely fertility evaluation and treatment in ways that challenge reproductive health equity will be presented.


Assuntos
Disparidades em Assistência à Saúde , Infertilidade/etnologia , Infertilidade/terapia , Medicina Reprodutiva , Afro-Americanos , Fertilização In Vitro , Acesso aos Serviços de Saúde , Humanos , Prognóstico
18.
Indian J Med Ethics ; VI(3): 1-9, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34287204

RESUMO

Infertility is a condition that has an inherent cultural significance. In India, married couples with infertility face the brunt of speculations and certain demeaning identities are assigned to the women. Care-seeking options for infertility are deeply gendered. The availability of technologically advanced treatments for infertility provides "hope" to couples, especially women, to resolve the demeaning identities assigned to them, related to infertility. The paper focuses on the moral dilemma faced by a medically trained public health professional while collecting data from women in Kerala who were unable to continue the suggested biomedical treatment. Infertility treatment is an entropic cycle of success and failure; thus, the women studied moved from one stage to another hoping for a resolution to their problem. They were also undergoing alternative treatments that were unlikely to succeed. The paper discusses the moral dilemma of choosing between explaining the poor likelihood of success and leaving them with "hope".


Assuntos
Infertilidade , Feminino , Humanos , Índia , Infertilidade/terapia , Princípios Morais , Aceitação pelo Paciente de Cuidados de Saúde , Cônjuges
19.
Fertil Steril ; 116(3): 801-808, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34210397

RESUMO

OBJECTIVE: To study the incidence and clinical significance of congenital heart defects (CHDs) detected by fetal echocardiography in pregnancies conceived by in vitro fertilization (IVF). DESIGN: Cohort study comparing a prospectively maintained database of all fetal echocardiograms from 2012 to 2018 and pooled data from the Connecticut Birth Defects Registry and statewide hospital discharge data. SETTING: Large tertiary care center. PATIENT(S): A total of 181,749 live births and 9,252 fetal echocardiograms were analyzed. Fetal echocardiograms in patients with a previous child with a CHD, a family history of CHD, medication exposure, diabetes, anomaly in previous pregnancy, cardiac or other abnormality noted on previous ultrasound, or monochorionic twins were excluded from the final analysis. INTERVENTION(S): Treatment with IVF. MAIN OUTCOME MEASURE(S): Incidence of CHD and odds ratios with 95% confidence intervals (CIs). Infant outcomes for cases of CHD were evaluated for clinically significant disease, defined a priori as disease requiring any medical or surgical intervention or continued follow-up with pediatric cardiology. RESULT(S): Fetal echocardiography was performed in 2,230 IVF pregnancies, of which 2,040 were without other known risk factors for CHD. The mean gestational age at the time of fetal echocardiography was 22.2 ± 1.4 weeks. The odds ratio for CHD in the IVF group compared with statewide population rates was 1.4 (95% CI 0.9-2.1). CHD was diagnosed in 26 fetuses, of which 21 were clinically insignificant ventricular septal defects. One fetal echocardiogram was concerning for pulmonary stenosis that was not present at birth. Four defects were clinically significant, indicating that 510 fetal echocardiograms were performed for every diagnosis of one clinically significant CHD in the IVF group. CONCLUSION(S): The incidence of CHD in IVF pregnancies without other risk factors is not significantly different from baseline population rates, and most CHDs diagnosed by fetal echocardiography in this group are clinically insignificant. Routine screening with fetal echocardiography in all IVF pregnancies provides limited utility beyond routine prenatal care and need not be recommended without the presence of other risk factors.


Assuntos
Ecocardiografia Doppler em Cores , Fertilização In Vitro , Coração Fetal/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Infertilidade/terapia , Ultrassonografia Pré-Natal , Bases de Dados Factuais , Feminino , Fertilização In Vitro/efeitos adversos , Coração Fetal/anormalidades , Cardiopatias Congênitas/epidemiologia , Humanos , Incidência , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Sistema de Registros , Medição de Risco , Fatores de Risco , Resultado do Tratamento
20.
Fertil Steril ; 116(3): 820-832, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34238571

RESUMO

OBJECTIVE: To explore windows of vulnerability to prenatal urinary phenol concentrations and preterm birth. DESIGN: Prospective cohort. SETTING: A large fertility center in Boston, Massachusetts. PATIENT(S): A total of 386 mothers who sought fertility treatment and gave birth to a singleton between 2005 and 2018. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Singleton live birth with gestational age <37 completed weeks. RESULT(S): Compared with women with non-preterm births, urinary bisphenol A (BPA) concentrations were higher across gestation among women with preterm births, particularly during mid-to-late pregnancy and among those with female infants. Second trimester BPA concentrations were associated with preterm birth (Risk Ratio [RR] 1.24; 95%CI: 0.92, 1.69), which was primarily driven by female (RR 1.40; 95%CI: 1.04, 1.89) and not male (RR 0.85; 95%CI 0.50, 1.46) infants. First trimester paraben concentrations were also associated with preterm birth (RR 1.17; 95%CI: 0.94, 1.46) and similarly the association was only observed for female (RR 1.46; 95% CI: 1.10, 1.94) and not male infants (RR 0.94; 95%CIC: 0.72, 1.23). First trimester urinary bisphenol S concentrations showed a suggested risk of preterm birth (RR 1.25; 95%CI: 0.82, 1.89), although the small case numbers precluded sex-specific examination. CONCLUSION(S): We found preliminary evidence of associations between mid-to-late pregnancy BPA and early pregnancy paraben concentrations with preterm birth among those with female infants only. Preterm birth risk may be compound, sex, and window specific. Given the limited sample size of this cohort, results should be confirmed in larger studies, including fertile populations.


Assuntos
Infertilidade/urina , Fenóis/efeitos adversos , Fenóis/urina , Nascimento Prematuro/induzido quimicamente , Adulto , Compostos Benzidrílicos/efeitos adversos , Compostos Benzidrílicos/urina , Biomarcadores/urina , Feminino , Fertilidade , Idade Gestacional , Humanos , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Infertilidade/terapia , Nascido Vivo , Masculino , Parabenos/efeitos adversos , Parabenos/metabolismo , Gravidez , Estudos Prospectivos , Técnicas de Reprodução Assistida , Medição de Risco , Fatores de Risco , Fatores Sexuais , Sulfonas/efeitos adversos , Sulfonas/urina , Resultado do Tratamento
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