Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.226
Filtrar
1.
Medwave ; 21(10): e8484, 2021 Nov 15.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-34780395

RESUMO

Proper communication between natural killer cells and the human leukocyte antigens of the embryonic trophoblast at the maternal-fetal interface during pregnancy is essential for successful reproduction. However, specific combinations of embryonic human leukocyte antigen-C with killer immunoglobulin-like receptors on decidual natural killer cells (the immunological code of pregnancy) can be associated with obstetric morbidity and pregnancy loss. This article presents an updated review of the mechanisms underlying the interaction between embryonic human leukocyte antigen-C and maternal killer immunoglobulin-like receptors and their relevance to the physiology and pathophysiology of human reproduction.


Assuntos
Aborto Habitual/imunologia , Antígenos HLA-C/imunologia , Células Matadoras Naturais/imunologia , Placentação/fisiologia , Receptores KIR/imunologia , Medicina Reprodutiva , Útero/imunologia , Aborto Espontâneo/imunologia , Implantação do Embrião/imunologia , Feminino , Antígenos HLA , Antígenos HLA-C/fisiologia , Humanos , Células Matadoras Naturais/fisiologia , Gravidez , Receptores KIR/fisiologia
2.
Theriogenology ; 176: 94-103, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34600433

RESUMO

Antifreeze proteins (AFPs) are synthesized by diverse non-mammalian species, allowing them to survive in severely cold environments. Since the 1990s, the scientific literature reports their use for low-temperature preservation of germplasm. The aim of this systematic review was to compile available scientific evidence regarding the use of AFP for low-temperature preservation of several reproductive specimens. Internet databases were consulted using the terms: "antifreeze protein" OR "AFP" OR "antifreeze glycoprotein" OR "AFGP" OR "ice-binding protein" OR "IBP" OR "thermal hysteresis protein" AND "cryopreservation". From 56 articles, 87 experiments testing AFPs in low-temperature preservation of gametes, embryos or reproductive tissues/cells were fully analyzed and outcomes were annotated. A positive outcome was considered as a statistically significant improvement on any parameter evaluated after low-temperature preservation with AFP, whereas a negative outcome included worsening of any evaluated parameter, in comparison to untreated groups or groups treated with a lower concentration of AFP. The findings indicated that research on the use of AFP as a cryoprotectant for reproductive specimens has increased markedly over the past decade. Some experiments reported both positive and negative results, which depended, on AFP concentration in the preservation media. Variation in the outcomes associated with species was also observed. Among the 66 experiments conducted in mammals, 77.3% resulted in positive, and 28.8% in negative outcomes after the use of AFP. In fishes, positive and negative outcomes were observed in 71.4% and 33.3% of 21 experiments, respectively. Most positive outcomes included preserving cell post-warming survival. The beneficial effect of AFP supports its use in cryobiological approaches used in human and veterinary medicines and animal protein industry. Moreover, combination of different AFP types, or AFP with antioxidants, or even the use of AFP-biosimilar, comprise some promising approaches to be further explored in cryopreservation.


Assuntos
Proteínas Anticongelantes , Medicina Reprodutiva , Animais , Criopreservação/veterinária , Crioprotetores , Temperatura
4.
Hum Reprod ; 36(11): 2824-2839, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34562078

RESUMO

Liquid biopsy is the process of sampling and analyzing body fluids, which enables non-invasive monitoring of complex biological systems in vivo. Liquid biopsy has myriad applications in health and disease as a wide variety of components, ranging from circulating cells to cell-free nucleic acid molecules, can be analyzed. Here, we review different components of liquid biopsy, survey state-of-the-art, non-invasive methods for detecting those components, demonstrate their clinical applications and discuss ethical considerations. Furthermore, we emphasize the importance of artificial intelligence in analyzing liquid biopsy data with the aim of developing ethically-responsible non-invasive technologies that can enhance individualized healthcare. While previous reviews have mainly focused on cancer, this review primarily highlights applications of liquid biopsy in reproductive medicine.


Assuntos
Ácidos Nucleicos Livres , Neoplasias , Medicina Reprodutiva , Inteligência Artificial , Biomarcadores Tumorais , Biópsia , Humanos , Biópsia Líquida
5.
Fertil Steril ; 116(4): 931-935, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34364678

RESUMO

Transgender men experience a disharmony between their birth sex and their intimate sense of gender belonging. Gender-affirming hormone therapy and gender-affirming surgery (GAS) are often inherently part of the gender-affirming process. In this context, we should ask whether it is better to keep or remove the uterus. Keeping the uterus and ovaries avoids a surgical procedure and a pubic scar. Furthermore, it preserves fertility and the possibility of carrying a baby. On the other hand, keeping the uterus is often psychologically unbearable for transgender men and the long-term effects of androgens on the uterus and ovaries remain uncertain. Conversely, hysterectomy and oophorectomy are part of the GAS process. New mini-invasive surgery procedures for hysterectomies decrease the risks and limit the likelihood of scars to a minimum. In practice, the data suggest that very few transgender men carry a pregnancy and/or use their oocytes after gender-reaffirming treatment. Clinicians should counsel their transgender men patients about the definitive infertility consequences of hysterectomy and oophorectomy and discuss all fertility preservation options before undertaking GAS. Individualized approaches must be preferred to systematic procedures regarding the personal decision to keep or not keep the uterus and ovaries.


Assuntos
Fertilidade , Serviços de Saúde para Pessoas Transgênero , Histerectomia , Ovariectomia , Medicina Reprodutiva , Procedimentos de Readequação Sexual , Pessoas Transgênero , Transexualidade/cirurgia , Androgênios/uso terapêutico , Aconselhamento , Feminino , Preservação da Fertilidade , Disforia de Gênero/psicologia , Identidade de Gênero , Humanos , Histerectomia/efeitos adversos , Masculino , Ovariectomia/efeitos adversos , Procedimentos de Readequação Sexual/efeitos adversos , Testosterona/uso terapêutico , Pessoas Transgênero/psicologia , Transexualidade/fisiopatologia , Transexualidade/psicologia , Resultado do Tratamento
6.
Fertil Steril ; 116(4): 919-921, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34399947

RESUMO

Gender dysphoria, a discrepancy between gender identity and genetically determined sex, is encountered in approximately 0.5% of people uniformly across the world. In the case of transgender men, formerly called female-to-male transsexuals, the available gender-affirming measures, hormone therapy and possible surgical procedures, are multiple and discussed in detail in this series of articles.


Assuntos
Androgênios/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia , Serviços de Saúde para Pessoas Transgênero , Medicina Reprodutiva , Procedimentos de Readequação Sexual , Testosterona/uso terapêutico , Pessoas Transgênero , Transexualidade/cirurgia , Androgênios/efeitos adversos , Feminino , Disforia de Gênero/psicologia , Identidade de Gênero , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos , Procedimentos de Readequação Sexual/efeitos adversos , Testosterona/efeitos adversos , Pessoas Transgênero/psicologia , Transexualidade/fisiopatologia , Transexualidade/psicologia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos
7.
Trials ; 22(1): 520, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362422

RESUMO

BACKGROUND: Randomised controlled trials in reproductive medicine are often subject to outcome truncation, where the study outcomes are only defined in a subset of the randomised cohort. Examples include birthweight (measurable only in the subgroup of participants who give birth) and miscarriage (which can only occur in participants who become pregnant). These outcomes are typically analysed by making a comparison between treatment arms within the subgroup (for example, comparing birthweights in the subgroup who gave birth or miscarriages in the subgroup who became pregnant). However, this approach does not represent a randomised comparison when treatment influences the probability of being observed (i.e. survival). The practical implications of this for the design and interpretation of reproductive trials are unclear however. METHODS: We developed a simulation platform to investigate the implications of outcome truncation for reproductive medicine trials. We used this to perform a simulation study, in which we considered the bias, type 1 error, coverage, and precision of standard statistical analyses for truncated continuous and binary outcomes. Simulation settings were informed by published assisted reproduction trials. RESULTS: Increasing treatment effect on the intermediate variable, strength of confounding between the intermediate and outcome variables, and the presence of an interaction between treatment and confounder were found to adversely affect performance. However, within parameter ranges we would consider to be more realistic, the adverse effects were generally not drastic. For binary outcomes, the study highlighted that outcome truncation could cause separation in smaller studies, where none or all of the participants in a study arm experience the outcome event. This was found to have severe consequences for inferences. CONCLUSION: We have provided a simulation platform that can be used by researchers in the design and interpretation of reproductive medicine trials subject to outcome truncation and have used this to conduct a simulation study. The study highlights several key factors which trialists in the field should consider carefully to protect against erroneous inferences. Standard analyses of truncated binary outcomes in small studies may be highly biassed, and it remains to identify suitable approaches for analysing data in this context.


Assuntos
Aborto Espontâneo , Medicina Reprodutiva , Viés , Feminino , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
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
9.
Fertil Steril ; 116(2): 292-295, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353571

RESUMO

The demographics of the United States are rapidly changing, and our health care workforce is not keeping pace with the population trends. The American Society for Reproductive Medicine (formerly The American Fertility Society) recognizes the need to increase diversity and is committed to promoting diversity across our membership and leadership as well as promoting equitable quality reproductive care to all patients. In the fall of 2020, the American Society for Reproductive Medicine convened a Diversity, Equity, and Inclusion Task Force to evaluate and make recommendations on the basis of findings to increase diversity to achieve equity and inclusion of reproductive and infertility services for all women. This article focuses on specific barriers that Black or African American patients face in accessing quality care and that provider's face in training and inclusion in reproductive medicine. Multiple publications have confirmed an improvement in health outcome when there is congruence between the patient and the provider. There is a stark contrast between the racial and ethnic diversity of our providers and other support personnel compared with that of our patients. Despite our best intent to minimize the effects of implicit and explicit bias, mistrust and misunderstandings when there is discordance between patients and providers negatively impacts care. To increase provider diversity, it is crucial that we prioritize pipeline programs that recruit and support underrepresented minority in medicine physicians. Specific recommendations are made to increase diversity in the pipeline to improve patient access to culturally competent quality reproductive medicine care with optimal outcomes.


Assuntos
Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Medicina Reprodutiva/educação , Afro-Americanos , Pessoal de Saúde , Mão de Obra em Saúde , Humanos , Mentores , Qualidade da Assistência à Saúde
10.
Fertil Steril ; 116(3): 651-654, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34330423

RESUMO

On the basis of American Society for Reproductive Medicine and Society for Assisted Reproductive Technology data, the American Society for Reproductive Medicine's guidelines for the limits on the number of embryos to be transferred during in vitro fertilization cycles have been further refined in continuing efforts to promote singleton gestation and reduce the number of multiple pregnancies. This version replaces the document titled "Criteria for number of embryos to transfer: a committee opinion" that was published most recently in August of 2017 (Fertil Steril 2017;107:901-3).


Assuntos
Transferência Embrionária/normas , Fertilização In Vitro/normas , Infertilidade/terapia , Medicina Reprodutiva/normas , Adulto , Tomada de Decisão Clínica , Consenso , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Idade Materna , Gravidez , Redução de Gravidez Multifetal/normas , Medição de Risco , Fatores de Risco , Transferência de Embrião Único/normas , Resultado do Tratamento
11.
BMC Pregnancy Childbirth ; 21(1): 495, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233646

RESUMO

BACKGROUND: Restorative reproductive medicine (RRM) seeks to identify and correct underlying causes and factors contributing to infertility and reproductive dysfunction. Many components of RRM are highly suitable for primary care practice. We studied the outcomes amongst couples who received restorative reproductive medicine treatment for infertility in a primary care setting. METHODS: Two family physicians in Massachusetts trained in a systematic approach to RRM (natural procreative technology, or NaProTechnology) treated couples with infertility. We retrospectively reviewed the characteristics, diagnoses, treatments, and outcomes for all couples treated during the years 1989 to 2014. We compared pregnancy and live birth by clinical characteristics using Kaplan-Meier analysis. We employed the Fleming-Harrington weighted Renyi test or the logrank test to compare the cumulative proportion with pregnancy or with live birth. RESULTS: Among 370 couples beginning treatment for infertility, the mean age was 34.8 years, the mean prior time trying to conceive was 2.7 years, and 27% had a prior live birth. The mean number of diagnoses per couple was 4.9. Treatment components included fertility tracking with the Creighton Model FertilityCare System (80%); medications to enhance cervical mucus production (81%), to stimulate ovulation (62%), or to support the luteal phase (75%); and referral to female laparoscopy by a surgeon specializing in endometriosis (46%). The cumulative live birth rate at 2 years was 29% overall; this was significantly higher for women under age 35 (34%), and for women with body mass index < 25 (40%). There were 2 sets of twins and no higher-order multiple gestations. Of the 63 births with data available, 58 (92%) occurred at term. CONCLUSIONS: Family physicians can provide a RRM approach for infertility to identify underlying causes and promote healthy term live births. Younger women and women with body mass index < 25 are more likely to have a live birth.


Assuntos
Medicina de Família e Comunidade/métodos , Infertilidade/terapia , Padrões de Prática Médica/estatística & dados numéricos , Medicina Reprodutiva/métodos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Adulto , Coeficiente de Natalidade , Feminino , Humanos , Recém-Nascido , Nascido Vivo , Massachusetts , Gravidez , Estudos Retrospectivos
13.
J Adv Res ; 31: 25-34, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34194830

RESUMO

Introduction: MicroRNAs (miRNAs) are important regulators of many biological functions, including embryo implantation and development. Recently, it has been reported that miRNAs in biofluids are predictive for physiological and pathological processes. Objectives: In this study, we aim to investigate whether the miRNAs secreted by human embryos in culture medium can be used as embryonic biomarkers. Methods: The culture media were prospectively collected from embryos of patients at reproductive medicine center with informed consent. A high-throughput miRNA sequencing method was applied to detect the miRNA profiles in the human embryo culture media. After bioinformatics analysis and screening of differentially expressed miRNAs, quantitative real-time polymerase chain reaction (qRT-PCR) assay was subsequently performed to further confirm the sequencing results with mixed samples. Furthermore, we performed droplet digital PCR (ddPCR) to verify the target miRNAs at single sample level. Receiver operating characteristic (ROC) analyses were performed for differentially expressed miRNAs. Results: Compared with embryos with failed pregnancy, the embryos with successful pregnancy secreted different miRNA profiles into the culture media, which were predicted to be involved in multiple biological processes. Validated by droplet digital polymerase chain reaction (ddPCR), the expression of hsa-miR-26b-5p and hsa-miR-21-5p in the culture media of cleavage embryos with successful pregnancy was significantly lower than that of embryos with failed pregnancy. Moreover, the Receiver Operating Characteristic (ROC) curve analysis indicated that hsa-miR-26b-5p and hsa-miR-21-5p could serve as potential biomarkers for reproductive outcomes. Conclusion: Together, our findings highlight the important predictive potential of miRNAs secreted by human embryos in culture media, which is meaningful for non-invasive embryo selection in assisted reproductive technology.


Assuntos
Embrião de Mamíferos/metabolismo , MicroRNAs/análise , Técnicas de Reprodução Assistida , Adulto , Biomarcadores/análise , Fase de Clivagem do Zigoto/metabolismo , Biologia Computacional/métodos , Meios de Cultura/química , Implantação do Embrião , Feminino , Humanos , MicroRNAs/metabolismo , Gravidez , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medicina Reprodutiva/métodos
15.
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
16.
Biol Reprod ; 105(4): 808-821, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34159367

RESUMO

The outbreak of the coronavirus disease 2019 (COVID-19) has created havoc on the socio-economic aspect of the world. With billions of lives being affected by this wrecking pandemic, global fertility services were also not left untouched by its impact. The possibility of sexual transmission of SARS-CoV-2 virus, its impact on male and female fertility, pregnancy, its potential teratogenic effect, and handling of gametes in the clinical laboratories were major concerns among reproductive medicine specialists, which led down all the reproductive health services, including IUI, IVF/ICSI in most of the countries. Even the people did not intend to conceive during the pandemic crisis and were hesitant to avail such services. Discrete evidence regarding the pathophysiology of COVID-19 infection and its impact on the human reproductive system is not very clear. In this review article, we intend to incorporate all the evidence related to the COVID-19 infection and its impact on human reproduction available to date. It is our responsibility to provide rightful information and to keep our patients familiar with the existing lack of clear evidence. In this COVID-19 era, it is important that the fertility management be prioritized in sub-fertile couples with diminished fertility reserve and high-risk conditions, like malignancies, that may affect their long-term fertility prospects.


Assuntos
COVID-19/complicações , Genitália , Infertilidade/etiologia , Pandemias , Medicina Reprodutiva/tendências , Fenômenos Reprodutivos Fisiológicos , Técnicas de Reprodução Assistida/tendências , Animais , Feminino , Preservação da Fertilidade , Humanos , Infertilidade/terapia , Masculino , Gravidez
19.
Fertil Steril ; 116(1): 13-14, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34148581

RESUMO

The goal of this Views and Interviews series was to bring together the thought leaders in the field and envision what the laboratory will look like in the future. This consensus piece strives to take the thoughts of those leaders and develop themes and concepts that will be significant in the laboratory in the coming years.


Assuntos
Andrologia/tendências , Inteligência Artificial/tendências , Serviços de Laboratório Clínico/tendências , Fertilização In Vitro/tendências , Infertilidade/terapia , Medicina Reprodutiva/tendências , Automação Laboratorial , Consenso , Difusão de Inovações , Feminino , Previsões , História do Século XXI , Humanos , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Masculino , Gravidez
20.
Fertil Steril ; 116(1): 36-47, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34148587

RESUMO

OBJECTIVE: To provide evidence-based recommendations to practicing physicians and others regarding the efficacy of oocyte cryopreservation (OC) for donor oocyte in vitro fertilization and planned OC. METHODS: The American Society for Reproductive Medicine conducted a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1986 to 2018. The American Society for Reproductive Medicine Practice Committee and a task force of experts used available evidence and through consensus developed evidence-based guideline recommendations. MAIN OUTCOME MEASURE(S): Outcomes of interest included live birth rate, clinical pregnancy rate, obstetrical and neonatal outcomes, and factors predicting reproductive outcomes. RESULT(S): The literature search identified 30 relevant studies to inform the evidence base for this guideline. RECOMMENDATION(S): Evidence-based recommendations were developed for predicting the likelihood of live births after planned OC, autologous OC in infertile women, and donor OC, as well as factors that may impact live birth rates. Recommendations were developed regarding neonatal outcomes after using fresh vs. cryopreserved oocytes in cases of autologous or donor oocytes. CONCLUSION(S): There is insufficient evidence to predict live birth rates after planned OC. On the basis of limited data, ongoing and live birth rates appear to be improved for women who undergo planned OC at a younger vs. older age. Although there are no significant differences in per transfer pregnancy rates with cryopreserved vs. fresh donor oocytes, there is insufficient evidence that the live birth rate is the same with vitrified vs. fresh donor oocytes. Neonatal outcomes appear similar with cryopreserved oocytes compared with fresh oocytes. Future studies that compare cumulative live birth rates are needed.


Assuntos
Criopreservação/normas , Preservação da Fertilidade/normas , Fertilização In Vitro/normas , Infertilidade Feminina/terapia , Recuperação de Oócitos/normas , Oócitos , Medicina Reprodutiva/normas , Adulto , Consenso , Medicina Baseada em Evidências/normas , Feminino , Fertilidade , Preservação da Fertilidade/efeitos adversos , Fertilização In Vitro/efeitos adversos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Nascido Vivo , Recuperação de Oócitos/efeitos adversos , Gravidez , Complicações na Gravidez/etiologia , Taxa de Gravidez , Fatores de Risco , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...