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2.
Chin Med Sci J ; 37(3): 261-264, 2022 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-36321181

RESUMO

Based on the macroanalysis of the unbalanced development of the "demand side" and the "supply side" of clinical medicine in China, this paper elucidates the stakeholders, resources, and ecosystem of the strategic scientific and technological capacity-building and calls for a larger coverage, smoother supply chain, and more sustainable ecosystem to ensure the development of clinical medicine. Furthermore, focusing on the establishment and development of clinical reproductive health in China, the authors introduce the strategic scientific and technological capacity-building of reproductive medicine in Peking University Third Hospital, with an attempt to inform similar efforts in other fields and even the whole clinical medicine in China.


Assuntos
Medicina Clínica , Medicina Reprodutiva , Humanos , Ecossistema , Universidades , China , Hospitais
3.
Fertil Steril ; 118(4): 668-670, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36075743

RESUMO

American Society for Reproductive Medicine affirms that completion of fellowship training in reproductive endocrinology and infertility meets the criteria for requisite education, training, and demonstrated competence to order, perform, and interpret gynecologic ultrasound imaging studies and hysterosalpingography. Additional accreditation through other organizations is not required. Certification and maintenance of certification through the American Board of Obstetrics and Gynecology satisfy the requirement of accreditation and currency.


Assuntos
Ginecologia , Obstetrícia , Medicina Reprodutiva , Certificação , Feminino , Ginecologia/educação , Humanos , Obstetrícia/educação , Gravidez , Medicina Reprodutiva/educação , Ultrassonografia , Estados Unidos
5.
Hum Reprod ; 37(10): 2359-2365, 2022 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-36066464

RESUMO

STUDY QUESTION: How is endometriosis extent described by the #Enzian classification compared to the revised American Society for Reproductive Medicine (rASRM) stages in women undergoing radical surgery for deep endometriosis (DE)? SUMMARY ANSWER: The prevalence and severity grade of endometriotic lesions and adhesions as well as the total number of #Enzian compartments affected by DE increase on average with increasing rASRM stage; however, DE lesions are also present in rASRM stages 1 and 2, leading to an underestimation of disease severity when using the rASRM classification. WHAT IS KNOWN ALREADY: Endometriotic lesions can be accurately described regarding their localization and severity by sonography as well as during surgery using the recently updated #Enzian classification for endometriosis. STUDY DESIGN, SIZE, DURATION: This was a prospective multicenter study including a total of 735 women between January 2020 and May 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Disease extent in women undergoing radical surgery for DE at tertiary referral centers for endometriosis was intraoperatively described using the #Enzian and the rASRM classification. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 735 women were included in the study. Out of 31 women with rASRM stage 1, which is defined as only minimal disease, 65% (i.e. 20 women) exhibited DE in #Enzian compartment B (uterosacral ligaments/parametria), 45% (14 women) exhibited DE in #Enzian compartment A (vagina/rectovaginal septum) and 26% (8 women) exhibited DE in #Enzian compartment C (rectum). On average, there was a progressive increase from rASRM stages 1-4 in the prevalence and severity grade of DE lesions (i.e. lesions in #Enzian compartments A, B, C, FB (urinary bladder), FU (ureters), FI (other intestinal locations), FO (other extragenital locations)), as well as of endometriotic lesions and adhesions in #Enzian compartments P (peritoneum), O (ovaries) and T (tubo-ovarian unit). In addition, the total number of #Enzian compartments affected by DE lesions on average progressively increased from rASRM stages 1-4, with a maximum of six affected compartments in rASRM stage 4 patients. LIMITATIONS, REASONS FOR CAUTION: Interobserver variability may represent a possible limitation of this study. WIDER IMPLICATIONS OF THE FINDINGS: The #Enzian classification includes the evaluation of DE in addition to the assessment of endometriotic lesions and adhesions of the ovaries and tubes and may therefore provide a comprehensive description of disease localization and extent in women with DE. STUDY FUNDING/COMPETING INTEREST(S): No funding was received for this study. All authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Endometriose , Medicina Reprodutiva , Endometriose/patologia , Feminino , Humanos , Estudos Prospectivos , Reto/patologia , Aderências Teciduais , Estados Unidos , Vagina
6.
Reprod Biomed Online ; 45(5): 899-905, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35927209

RESUMO

This review appraises evidence on the difference between single- and double-embryo transfer (SET, DET) in assisted reproductive technology (ART) regarding the four healthcare quality dimensions most important to fertility patients and doctors. Regarding safety, not only does DET create the uncontested perinatal risks of twin pregnancies, but compelling evidence has added that singleton pregnancies after a vanishing twin also have poorer perinatal outcomes. SET is as effective as DET, as shown by meta-analyses of randomized controlled trials, comparing two cycles of SET versus DET and shown by cumulative live birth rates of entire ART trajectories of up to six cycles. Proposing SET, which is safer than DET and as effective, as the gold standard is not irreconcilable with patient-centred care if patients are thoroughly informed on the reasoning behind the proposition and welcomed to challenge whether it fits their personal values. The cost-efficiency of SET is clearly higher, which has even induced certain countries to start reimbursing ART on the condition that SET is used. In conclusion, SET should be the gold standard offered to all patients. The question is not whether to apply SET but how to apply it in terms of patient selection, patient-centred counselling and coverage of treatment.


Assuntos
Transferência Embrionária , Medicina Reprodutiva , Gravidez , Feminino , Humanos , Transferência Embrionária/métodos , Fertilização In Vitro , DEET , Qualidade da Assistência à Saúde , Taxa de Gravidez
7.
Reprod Biol Endocrinol ; 20(1): 111, 2022 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927756

RESUMO

The American Society for Reproductive Medicine estimates that fewer than a quarter of infertile couples have sufficient access to infertility care. Insurers in the United States (US) have long considered infertility to be a socially constructed condition, and thus in-vitro fertilization (IVF) an elective intervention. As a result, IVF is cost prohibitive for many patients in the US. State infertility insurance mandates are a crucial mechanism for expanding access to fertility care in the US in the absence of federal legislation. The first state insurance mandate for third party coverage of infertility services was passed by West Virginia in 1977, and Maryland passed the country's first IVF mandate in 1985. To date, twenty states have passed legislation requiring insurers to cover or offer coverage for the diagnosis and treatment of infertility. Ten states currently have "comprehensive" IVF mandates, meaning they require third party coverage for IVF with minimal restrictions to patient eligibility, exemptions, and lifetime limits. Several studies analyzing the impact of infertility and IVF mandates have been published in the past 20 years. In this review, we characterize and contextualize the existing evidence of the impact of state insurance mandates on access to infertility treatment, IVF practice patterns, and reproductive outcomes. Furthermore, we summarize the arguments in favor of insurance coverage for infertility care and assess the limitations of state insurance mandates as a strategy for increasing access to infertility treatment. State mandates play a key role in the promotion of evidence-based practices and represent an essential and impactful strategy for the advancement of gender equality and reproductive rights.


Assuntos
Infertilidade , Medicina Reprodutiva , Fertilização In Vitro , Humanos , Infertilidade/diagnóstico , Infertilidade/terapia , Cobertura do Seguro , Estados Unidos
9.
Reprod Domest Anim ; 57(11): 1287-1294, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35871399

RESUMO

Platelet-rich plasma (PRP) is the fraction of the plasma enriched with a platelet level above baseline, and it plays an essential role in tissue regeneration. The attention to PRP as unconventional therapy has increased during the past two decades. In animals, applications of PRP showed various degrees of success in a wide range of medical applications, from musculoskeletal injuries to ovarian insufficiency. Therapeutic applications with PRP in farm animals are still scarce, but the promising results offered by several studies are expected to trigger more interest in its application by both veterinarians and farmers. In this review, we highlight some efforts made in the field of animal reproduction regarding the use of PRP to potentiate the ovarian hypofunction, treat endometritis, improve the follicular development, oocyte competence and uterine environment for embryo implantation as well as restore testicular and erectile function in male, and as a treatment for mastitis.


Assuntos
Doenças Ovarianas , Plasma Rico em Plaquetas , Medicina Reprodutiva , Feminino , Masculino , Animais , Estudos Prospectivos , Doenças Ovarianas/veterinária , Oócitos
10.
J Am Vet Med Assoc ; 260(S2): S5, 2022 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-35905168
13.
Fertil Steril ; 118(2): 239-246, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35787921

RESUMO

Climate change has led to a multitude of ecological disruptions and downstream reproductive health consequences that impair our reproductive capacity and, in turn, harm the health and survival of future generations. Atmospheric changes, driven by anthropogenic emissions, expose global populations to droughts, heat waves, rising sea levels, and extreme weather events-posing major threats to public health and exacerbating environmental health disparities. Existing evidence demonstrates the potential for climate-driven events to impact reproductive health outcomes, yet very few studies have explored this relationship. Recently, the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, and the International Federation of Gynecology and Obstetrics released position statements regarding reproductive health and environmental exposures. Unfortunately, such initiatives have yielded little action within the health care system. To address this stagnation, health care workers must meld research findings into actionable preventive medicine strategies and transition to a more action-oriented approach to address the climate crisis. The objective of this article is to elucidate the urgency of the climate crisis in relation to reproductive health and push the health care workers to recognize their intrinsic opportunity as leaders in climate action at local, state, national, and international levels. We call on health care organizations and health care workers to leverage their inherent positions as climate action leaders to increase climate resilience and mitigate climate-related adverse reproductive health outcomes.


Assuntos
Mudança Climática , Medicina Reprodutiva , Humanos , Liderança , Saúde Pública
14.
Curr Opin Obstet Gynecol ; 34(4): 159-163, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35895955

RESUMO

PURPOSE OF REVIEW: Artificial Intelligence, a tool that integrates computer science and machine learning to mimic human decision-making processes, is transforming the world and changing the way we live. Recently, the healthcare industry has gradually adopted artificial intelligence in many applications and obtained some degree of success. In this review, we summarize the current applications of artificial intelligence in Reproductive Endocrinology, in both laboratory and clinical settings. RECENT FINDINGS: Artificial Intelligence has been used to select the embryos with high implantation potential, proper ploidy status, to predict later embryo development, and to increase pregnancy and live birth rates. Some studies also suggested that artificial intelligence can help improve infertility diagnosis and patient management. Recently, it has been demonstrated that artificial intelligence also plays a role in effective laboratory quality control and performance. SUMMARY: In this review, we discuss various applications of artificial intelligence in different areas of reproductive medicine. We summarize the current findings with their potentials and limitations, and also discuss the future direction for research and clinical applications.


Assuntos
Infertilidade , Medicina Reprodutiva , Inteligência Artificial , Feminino , Humanos , Aprendizado de Máquina , Gravidez
15.
J Med Case Rep ; 16(1): 246, 2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35729591

RESUMO

BACKGROUND: Restorative reproductive medicine represents a comprehensive approach to subfertility (infertility and miscarriage) with investigations, diagnoses, and treatments combined with fertility charting to restore optimal reproductive function. Restorative reproductive medicine assumes that multiple factors need to be identified and treated (cycle optimization) for up to 12 cycles to achieve a successful pregnancy. Conception can occur during normal intercourse without intrauterine insemination or in vitro fertilization. CASE PRESENTATION: A 35-year-old Croatian female presented for fertility treatment in May 2019 with a previous diagnosis of polycystic ovaries, infertility of 16 years duration, and 8 unsuccessful embryo transfers with in vitro fertilization and intracytoplasmic sperm injection. She was gravida 3 para 0, with 2 miscarriages after spontaneous conception at 5-6 weeks gestation in 2002 and 2004, followed by a miscarriage after in vitro fertilization at 12 weeks gestation in 2011. We initially found poor follicle function and suboptimal progesterone levels. Restorative reproductive medicine treatment resulted in conception after two cycles of treatment. This pregnancy ended in miscarriage at 7 weeks 4 days. Additional investigations found a balanced Robertsonian translocation (13, 14) and a uterine septum. We achieved repeat fertilization with restorative reproductive medicine after three cycles of treatment following resection of the uterine septum and ovulation induction with letrozole and human chorionic gonadotrophin. She had a full-term healthy pregnancy and live birth in 2021. CONCLUSION: We propose that a full evaluation of underlying factors, and up to 12 cycles of cycle optimization, should be offered to subfertile patients before considering in vitro fertilization treatment.


Assuntos
Aborto Habitual , Infertilidade , Medicina Reprodutiva , Aborto Habitual/terapia , Adulto , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro , Humanos , Gravidez , Injeções de Esperma Intracitoplásmicas
16.
Reprod Domest Anim ; 57 Suppl 5: 34-44, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35748405

RESUMO

Ultrasound technology has led to new lines of research in equine reproduction, and it has helped to greatly improve clinical diagnosis and reproductive outcomes in equine practice. This review aims to discuss the potential clinical uses and new approaches of ultrasonography in equine reproduction. Doppler modalities are usually used to evaluate the vascularization of the follicles, corpus luteum (CL), and the uterus in the mare for diagnostic purposes. Inclusion of Doppler ultrasound in artificial insemination and embryo transfer programs could improve the reproductive outcome of these techniques. Better selection of recipients based on CL functionality, early pregnancy diagnosis 7-8 days postovulation of the donor before flushing or diagnosis of mares with endometritis with pathological increases of blood flow are examples of clinical applications in the mare. In the stallion, colour Doppler ultrasound has improved the diagnostic potential of B-mode ultrasound, improving the differential diagnosis of pathologies such as testicular torsion (decrease or absence of blood flow in the cord) and orchitis (increased blood flow in the cord). The incorporation of pulsed Doppler ultrasound into the reproductive evaluation of the stallion has enabled early identification of stallions with testicular dysfunction, thus allowing administration of timely treatment and subsequent improvements of the fertility prognosis for these animals. In addition, this technique has been used in the monitoring of patients undergoing medical and surgical treatments, thus verifying their efficacy. Recently, computer-assisted pixel analysis using specific software has been performed in research work in order to semi-quantitatively evaluate the vascularization (colour and power Doppler) and echotexture of different organs. These softwares are now being developed for clinical purposes, as is the case with Ecotext, a computer program developed for the evaluation of testicular echotexture, providing information on testicular functionality.


Assuntos
Corpo Lúteo , Medicina Reprodutiva , Animais , Corpo Lúteo/irrigação sanguínea , Feminino , Cavalos , Inseminação Artificial/veterinária , Masculino , Gravidez , Ultrassonografia/veterinária , Ultrassonografia Doppler em Cores
19.
Artigo em Inglês | MEDLINE | ID: mdl-35627436

RESUMO

The impact of the COVID-19 pandemic on global healthcare workers' (HCWs) mental health has been well documented in the last two years; however, little is known regarding HCWs working in specific healthcare fields. During two subsequent periods of national lockdown in Italy (June-July 2020, T1, and November-December 2020, T2), a total sample of 47 HCWs working in a reproductive medicine hospital unit completed an ad hoc questionnaire for assessing emotional reactions to the pandemic, stress symptoms, and ways of coping. Moderate-high levels of anger and sadness were experienced by 65.9% and 68.1% of the HCWs, respectively, while moderate-high levels of anxiety and fear were experienced by 51.1% and 56.8%, respectively. Higher stress symptoms experienced by HCWs were hypervigilance, avoidance of thoughts and memories, and tiredness/low energy. At T2, levels of hypervigilance, irritability, intrusive thoughts, and detachment were higher than at T1, while avoidance of external triggers decreased. Moderate-high levels of anxiety resulted significantly associated with several symptoms of stress: irritability/fearfulness, depression/hopelessness, tiredness/low energy, problems with concentration, and intrusive thoughts. Regarding coping strategies, HCWs tended to adopt more problem-focused coping (e.g., contributing to improving a situation) and this tendency was higher at T2. Overall findings suggest a risk for the persistence of stress symptoms and, therefore, a risk for a chronic course, which might interfere with the global quality of mental health at work and the care provided to patients. Clinical implications highlight the relevance of implementing support programs for this category of HCWs focused on the elaboration of negative emotions and on fostering adaptive coping strategies.


Assuntos
COVID-19 , Medicina Reprodutiva , Adaptação Psicológica , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Emoções , Pessoal de Saúde/psicologia , Humanos , Pandemias
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