Exploring women's attitudes, knowledge, and intentions to use oocyte freezing for non-medical reasons: A systematic review.

INTRODUCTION: Women are postponing childbearing and preventing age-related fertility decline with oocyte freezing for non-medical reasons (OFNMR). The objective of this systematic evaluation was to gain an understanding of women's attitudes and knowledge of, and intentions to use OFNMR among users of OFNMR and the general public. MATERIAL AND METHODS: A systematic search of MEDLINE, EMBASE, and PyschINFO databases was undertaken, for studies that examined the psychosocial attitudes among women toward OFNMR. The search was limited to English language and no time restriction was set for publications. Extracted data were analyzed using thematic analysis and the study was performed according to PRISMA guidelines with prospective PROSPERO registration (CRD4201912578). RESULTS: Overall, 35 studies met the inclusion criteria. Studies were broadly categorized into studies investigating users or potential users of OFNMR, and studies examining the views of members of the general public. Users of OFNMR have good knowledge of age-related fertility decline and awareness of the OFNMR procedure. Lack of partner was identified as the most common motivating factor to undertake OFNMR, with cost as a predominant concern. Knowledge among the general public of OFNMR is highly variable. Underestimation of age-related fertility decline is common among the general public. Intentions of women to use OFNMR also varied drastically between studies. CONCLUSIONS: Women are predominantly motivated to freeze eggs by the lack of a suitable partner, but cost is a significant barrier. Increasing the number of women pursuing OFNMR at an earlier stage may positively impact upon the risk of future involuntary childlessness. Better information should be made available to both women and men about their fertility and options to inform their reproductive decision-making.

Fetal programming of adult Leydig cell function by androgenic effects on stem/progenitor cells.

Fetal growth plays a role in programming of adult cardiometabolic disorders, which in men, are associated with lowered testosterone levels. Fetal growth and fetal androgen exposure can also predetermine testosterone levels in men, although how is unknown, because the adult Leydig cells (ALCs) that produce testosterone do not differentiate until puberty. To explain this conundrum, we hypothesized that stem cells for ALCs must be present in the fetal testis and might be susceptible to programming by fetal androgen exposure during masculinization. To address this hypothesis, we used ALC ablation/regeneration to identify that, in rats, ALCs derive from stem/progenitor cells that express chicken ovalbumin upstream promoter transcription factor II. These stem cells are abundant in the fetal testis of humans and rodents, and lineage tracing in mice shows that they develop into ALCs. The stem cells also express androgen receptors (ARs). Reduction in fetal androgen action through AR KO in mice or dibutyl phthalate (DBP) -induced reduction in intratesticular testosterone in rats reduced ALC stem cell number by ∼40% at birth to adulthood and induced compensated ALC failure (low/normal testosterone and elevated luteinizing hormone). In DBP-exposed males, this failure was probably explained by reduced testicular steroidogenic acute regulatory protein expression, which is associated with increased histone methylation (H3K27me3) in the proximal promoter. Accordingly, ALCs and ALC stem cells immunoexpressed increased H3K27me3, a change that was also evident in ALC stem cells in fetal testes. These studies highlight how a key component of male reproductive development can fundamentally reprogram adult hormone production (through an epigenetic change), which might affect lifetime disease risk.

Managing a new diagnosis of interstitial lung disease in pregnancy.

Interstitial lung disease (ILD) presents rarely in pregnancy. Reports have associated disease activity with higher rates of preeclampsia, preterm births and fetal loss. This case report describes a patient presenting in her fifth pregnancy with worsening dyspnoea. She was treated with tacrolimus, prednisolone and post-partum methylprednisolone and ultimately had a successful outcome of childbirth.

To Fight or to Flee? A Systematic Review of Ectopic Pregnancy Management and Complications During the Covid-19 Pandemic.

BACKGROUND/AIM: During the COVID-19 pandemic, concerns regarding theoretical risks of surgery contributed to changes in clinical management to prevent contamination. We looked at the effect the pandemic had on the management of ectopic pregnancy. Our review compares published data on pre-COVID to COVID management of ectopic pregnancies and evaluates the differences where Early Pregnancy Unit (EPU) structures exist. MATERIALS AND METHODS: We performed a systematic review of the published evidence using a keyword strategy. The "Population Intervention Comparison and Outcome" (PICO) criteria were used to select studies. Three independent reviewers agreed on the data extracted after screening of the literature. The total population analysed included 3122 women. A meta-analysis of the included studies was completed using a random or fixed effect model depending on the heterogeneity (I2). Our outcomes were the following: type of management of ectopic pregnancy (EP), incidence of ruptured EP and rate of complications. We compared units with and without EPU infrastructure. RESULTS: We included every study which recruited women diagnosed with ectopic pregnancy and compared the type of management during and prior the COVID-19 peak. Our literature search yielded 34 papers. 12 were included using the PRISMA guidelines. We observed no difference in the type of management (surgical versus non-surgical) [OR=0.99 (0.63-1.55), p=0.96, I2=77%] in the pre-Covid vs. Covid cohorts overall but a reduction of surgical management in EPU structures. There was no difference in the ectopic rupture rate within the EPU branch [OR=0.66 (0.33-1.31), p=0.24, I2=37%]. In contrast, in non-EPU (NPEU) structures there was a clear increased risk of ruptured ectopic pregnancy [OR=2.86 (1.84-4.46), p<0.01 I2=13%] and complications [OR=1.69 (1.23-2.31), p=0.001, I2=45%]. CONCLUSION: The risk of ruptured ectopic and complications was significantly higher in the absence of EPU structures. This worldwide trend was not reflected in the UK, where EPU systems are widespread, suggesting that EPU structures contributed to prompt diagnosis and safe management. In the post-COVID era, healthcare systems have come to realise that pandemics might become the norm and thus the onus is to identify services that have worked seamlessly.

Investigating attitudes towards oocyte donation amongst potential donors and the general population: a systematic review.

With a current shortage of oocyte donors in the United Kingdom (UK), the psychological factors determining intentions to donate oocytes are important to understand. The objectives of this review were to explore psychosocial aspects of potential oocyte donors, including attitudes, motivations, as well as any issues surrounding potential donor disclosure and anonymity. A systematic search of English peer-reviewed journals of three computerized databases following PRISMA guidelines was conducted. Only English language peer-reviewed studies that have examined the psychosocial aspects of oocyte donation (OD) amongst potential oocyte donors were included. No time restriction was set for date of publication. A total of 39 studies were included which were analysed using thematic analysis. Broadly, authors have reported positive attitudes towards OD, however, knowledge surrounding OD within the general population is poor. Three key themes were identified as influencing the decision to donate: (i) altruism; (ii) financial motivation; and (iii) experience of fertility problems through friends. There were distinct differences in motivations to donate amongst potential donors according to demographics including fertility status, parity, ethnicity and religious background. Attitudes towards disclosure and anonymity appear complex. This is the first systematic review to examine potential oocyte donors exclusively and provides progressive information on the psychosocial complexities which may influence the crucial decision to donate. An increased number of well-designed studies exploring the psychological factors affecting the donation decision could allow more directed assessment and counselling for potential oocyte donors, which may lead to an increase in donor recruitment.

Investigating knowledge and perceptions of egg sharing among healthcare professionals in the United Kingdom.

OBJECTIVE: This study aims to determine the healthcare professionals knowledge and opinions of egg sharing and does this potentially effect egg sharing numbers in the UK? STUDY DESIGN: 304 healthcare professionals undertook a large, in-depth survey about various topics related to egg sharing. This included ranking key benefits and issues related to egg sharing. Statistical analysis was performed using SPSS. RESULTS: 63.1% of respondents had little or no knowledge of egg sharing, although the majority supported the scheme once a short description was provided. Although attitudes towards egg sharing were positive, there was more support for voluntary donation. The issues surrounding egg sharing of most concern were the psychological well-being of the egg sharer if her own treatment is unsuccessful and the concern that giving away half her eggs reduces IVF success rates. Only 16.5% of respondents had previously referred a patient for egg sharing, with the majority citing lack of knowledge for the reason they hadn't referred. CONCLUSIONS: Egg sharing allows women to receive free or subsidised IVF in exchange for donating half their oocytes collected to a recipient. Although egg sharing was intended to solve the current donor oocyte shortage, egg sharing numbers have fallen over recent years. Education of healthcare professionals about the egg sharing programme and the research that supports it could improve their perceptions of egg sharing, increasing referral rates and egg sharing numbers.

Inter-relationship between testicular dysgenesis and Leydig cell function in the masculinization programming window in the rat.

The testicular dysgenesis syndrome (TDS) hypothesis proposes that maldevelopment of the testis, irrespective of cause, leads to malfunction of the somatic (Leydig, Sertoli) cells and consequent downstream TDS disorders. Studies in rats exposed in utero to di(n-butyl) phthalate (DBP) have strongly supported the TDS concept, but so far no direct evidence has been produced that links dysgenesis per se to somatic cell dysfunction, in particular to androgen production/action during the 'masculinization programming window' (MPW; e15.5-e18.5). Normal reproductive tract development and anogenital distance (AGD) are programmed within the MPW, and TDS disorders arise because of deficiencies in this programming. However, DBP-induced focal testicular dysgenesis (Leydig cell aggregation, ectopic Sertoli cells, malformed seminiferous cords) is not evident until after the MPW. Therefore, we used AGD as a read-out of androgen exposure in the MPW, and investigated if this measure was related to objectively quantified dysgenesis (Leydig cell aggregation) at e21.5 in male fetuses exposed to vehicle, DBP (500 or 750 mg/kg/day) or the synthetic glucocorticoid dexamethasone (Dex; alone or plus DBP-500) from e15.5-e18.5 (MPW), e13.5-e20.5 or e19.5-e20.5 (late window). Dysgenesis was found only in animals exposed to DBP during the MPW, and was negatively correlated (R²â€Š= -0.5) with AGD at e21.5 and at postnatal day 8, irrespective of treatment period. Dysgenesis was also negatively correlated (R² = -0.5) with intratesticular testosterone (ITT) at e21.5, but only when treatments in short windows (MPW, late window) were excluded; the same was true for correlation between AGD and ITT. We conclude that AGD, reflecting Leydig cell function solely within the MPW, is strongly related to focal dysgenesis. Our results point to this occurring because of a common early mechanism, targeted by DBP that determines both dysgenesis and early (during the MPW) fetal Leydig cell dysfunction. The findings provide strong validation of the TDS hypothesis.