Pub Date : 2013-07-01DOI: 10.1586/14787210.2013.811947
J. Stern
Transfer of multiple embryos for IVF was an early and important advance to improve procedure effectiveness. Along with the increase in live birth rate, this advance resulted in a three-decade long battle to counteract high rates of multiple delivery that have accompanied multiple embryo transfer. This review chronicles the history of the struggle in the USA to reduce the number of embryos transferred and the multiple births that resulted from this practice while continuing to strive for high live birth delivery rates in young as well as older patients. The positive and negative influences of law, professional guidelines, inadequate medical insurance and patient preference are discussed. Recent reporting strategies and technical advances in embryo selection that can help us achieve single embryo transfer are reviewed.
{"title":"An overview of temporal trends in multiple births after assisted reproductive technology in the USA","authors":"J. Stern","doi":"10.1586/14787210.2013.811947","DOIUrl":"https://doi.org/10.1586/14787210.2013.811947","url":null,"abstract":"Transfer of multiple embryos for IVF was an early and important advance to improve procedure effectiveness. Along with the increase in live birth rate, this advance resulted in a three-decade long battle to counteract high rates of multiple delivery that have accompanied multiple embryo transfer. This review chronicles the history of the struggle in the USA to reduce the number of embryos transferred and the multiple births that resulted from this practice while continuing to strive for high live birth delivery rates in young as well as older patients. The positive and negative influences of law, professional guidelines, inadequate medical insurance and patient preference are discussed. Recent reporting strategies and technical advances in embryo selection that can help us achieve single embryo transfer are reviewed.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"65 1","pages":"357-368"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78358868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1586/17474108.2013.811933
E. Lewis, H. Cook, A. DeCherney
The luteal phase is a critical component in supporting early pregnancy by forming the corpus luteum, and priming the endometrium for implantation following conception. Unfortunately, in assisted reproductive technology, ovarian stimulation protocols disrupt the hormonal milieu of the menstrual cycle, resulting in a largely defective luteal phase. For the last three decades, the optimum regimen for luteal phase support in assisted reproductive technology has been explored. Human chorionic gonadotropin was one of the first agents utilized to rescue the corpus luteum, given its high affinity for luteinizing hormone receptor. In this article, the author will summarize the role of human chorionic gonadotropin for luteal support in improving reproductive outcomes.
{"title":"Luteal phase support with human chorionic gonadotropin in assisted reproductive technology","authors":"E. Lewis, H. Cook, A. DeCherney","doi":"10.1586/17474108.2013.811933","DOIUrl":"https://doi.org/10.1586/17474108.2013.811933","url":null,"abstract":"The luteal phase is a critical component in supporting early pregnancy by forming the corpus luteum, and priming the endometrium for implantation following conception. Unfortunately, in assisted reproductive technology, ovarian stimulation protocols disrupt the hormonal milieu of the menstrual cycle, resulting in a largely defective luteal phase. For the last three decades, the optimum regimen for luteal phase support in assisted reproductive technology has been explored. Human chorionic gonadotropin was one of the first agents utilized to rescue the corpus luteum, given its high affinity for luteinizing hormone receptor. In this article, the author will summarize the role of human chorionic gonadotropin for luteal support in improving reproductive outcomes.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"43 1","pages":"319-328"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89907195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is pre-pregnancy weight a risk factor for intellectual disability?","authors":"J. Mann, C. Deroche, L. Spiryda, S. McDermott","doi":"10.1586/EOG.13.10","DOIUrl":"https://doi.org/10.1586/EOG.13.10","url":null,"abstract":"","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"30 1","pages":"197-199"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75682659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the lack of consensus among groups issuing recent guidelines, it is possible to identify options that are available for prenatal practitioners. Examples include the following: iodine supplements to protect against hypothyroidism; adjusting l-thyroxine dosage upward in women with previously diagnosed hypothyroidism to account for increased pregnancy needs; and screening for undetected thyroid deficiency via targeted questions and/or thyroid-stimulating hormone testing. Decision-making about thyroid status requires access to reliable, trimester-specific normative data for both thyroid-stimulating hormone and free thyroxine, as well as an understanding of the impact of human chorionic gonadotropin on thyroid function, especially during the first trimester. Continuity of care is enhanced by systematic follow-up postpartum, including attention to postpartum thyroid dysfunction that often occurs among women with raised antibody levels.
{"title":"Preventing, identifying and managing thyroid deficiency in prenatal practice","authors":"J. Haddow","doi":"10.1586/EOG.13.16","DOIUrl":"https://doi.org/10.1586/EOG.13.16","url":null,"abstract":"Despite the lack of consensus among groups issuing recent guidelines, it is possible to identify options that are available for prenatal practitioners. Examples include the following: iodine supplements to protect against hypothyroidism; adjusting l-thyroxine dosage upward in women with previously diagnosed hypothyroidism to account for increased pregnancy needs; and screening for undetected thyroid deficiency via targeted questions and/or thyroid-stimulating hormone testing. Decision-making about thyroid status requires access to reliable, trimester-specific normative data for both thyroid-stimulating hormone and free thyroxine, as well as an understanding of the impact of human chorionic gonadotropin on thyroid function, especially during the first trimester. Continuity of care is enhanced by systematic follow-up postpartum, including attention to postpartum thyroid dysfunction that often occurs among women with raised antibody levels.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"6 1","pages":"213-222"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77771244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The effect of uterine leiomyoma on fertility is subject to continuous debate. IVF provides a unique opportunity to examine the effect of leiomyoma on embryonic implantation rate. Over the last two decades, many studies were published associating fibroids and infertility. Taken together these publications indicate that the implantation rate and pregnancy outcome is impaired in women with uterine leiomyoma when they cause deformation of the uterine cavity. In such patients, surgical treatment should be considered prior to IVF because of the reduced implantation rate, however, there are few prospective controlled studies that test the hypothesis that myomectomy with its inherent risks can help. In patients with intramural leiomyoma not invading the uterine cavity, the confusion still persists. Furthermore, even if one accepts that a negative effect of such fibroids exists, there is no direct proof that myomectomy results offer a better prognosis.
{"title":"Should we operate on fibroids before IVF","authors":"Z. Ben-Rafael","doi":"10.1586/eog.13.11","DOIUrl":"https://doi.org/10.1586/eog.13.11","url":null,"abstract":"The effect of uterine leiomyoma on fertility is subject to continuous debate. IVF provides a unique opportunity to examine the effect of leiomyoma on embryonic implantation rate. Over the last two decades, many studies were published associating fibroids and infertility. Taken together these publications indicate that the implantation rate and pregnancy outcome is impaired in women with uterine leiomyoma when they cause deformation of the uterine cavity. In such patients, surgical treatment should be considered prior to IVF because of the reduced implantation rate, however, there are few prospective controlled studies that test the hypothesis that myomectomy with its inherent risks can help. In patients with intramural leiomyoma not invading the uterine cavity, the confusion still persists. Furthermore, even if one accepts that a negative effect of such fibroids exists, there is no direct proof that myomectomy results offer a better prognosis.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"71 1","pages":"205-211"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87701585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Perrin, M. Nguyen, N. Douet-Guilbert, F. Morel, M. Braekeleer
Selection of a spermatozoon presenting both motility and normal morphology is one of the main concerns in intracytoplasmic sperm injection. Spermatozoa appearing as morphologically normal at the 400× magnification could carry various structural abnormalities that could negatively influence embryo development and pregnancy establishment, but only be detected with the use of higher optical magnifications. This led to the development of motile sperm organelle morphology examination (MSOME), which can achieve magnification ranging from 6300× to 13000×. Several approaches were used to classify spermatozoa. However, the prevalence of morphologically normal spermatozoa in MSOME is low (usually less than 5%). The most striking abnormalities are vacuoles, thought to be of acrosomal and/or nuclear origin and related to failure of sperm chromatin condensation. Twelve years after the introduction of MSOME, many questions remain unsolved. A consensual definition of a ‘normal’ spermatozoon and a classification of abnor...
{"title":"Motile sperm organelle morphology examination: where do we stand 12 years later?","authors":"A. Perrin, M. Nguyen, N. Douet-Guilbert, F. Morel, M. Braekeleer","doi":"10.1586/EOG.13.13","DOIUrl":"https://doi.org/10.1586/EOG.13.13","url":null,"abstract":"Selection of a spermatozoon presenting both motility and normal morphology is one of the main concerns in intracytoplasmic sperm injection. Spermatozoa appearing as morphologically normal at the 400× magnification could carry various structural abnormalities that could negatively influence embryo development and pregnancy establishment, but only be detected with the use of higher optical magnifications. This led to the development of motile sperm organelle morphology examination (MSOME), which can achieve magnification ranging from 6300× to 13000×. Several approaches were used to classify spermatozoa. However, the prevalence of morphologically normal spermatozoa in MSOME is low (usually less than 5%). The most striking abnormalities are vacuoles, thought to be of acrosomal and/or nuclear origin and related to failure of sperm chromatin condensation. Twelve years after the introduction of MSOME, many questions remain unsolved. A consensual definition of a ‘normal’ spermatozoon and a classification of abnor...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"os-8 1","pages":"249-260"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87027022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Choices for family planning have increased since the availability of postpartum tubal ligation. Hysteroscopic tubal occlusion is set to become the method of choice for interval sterilization. However, hormonal contraception has proven to bring substantial additional benefits, such as reduced menstrual discomfort and treatment of hyperandrogenism among the most noted. Arguably, the back-to-back use of long-acting hormonal contraceptives, such as the intrauterine delivery systems, can be considered to be ‘permanent’ contraceptive alternatives to surgical sterilization. For surgical sterilization to become an attractive alternative, there is a tendency to combine sterilization with other procedures, such as endometrial ablation. The current geo-political climate is unfavorable with regards to family planning, and the antagonism between religion and the state continues to flare with every debate on the subject of contraception.
{"title":"Emerging trends in female permanent contraception","authors":"T. Vancaillie","doi":"10.1586/EOG.13.17","DOIUrl":"https://doi.org/10.1586/EOG.13.17","url":null,"abstract":"Choices for family planning have increased since the availability of postpartum tubal ligation. Hysteroscopic tubal occlusion is set to become the method of choice for interval sterilization. However, hormonal contraception has proven to bring substantial additional benefits, such as reduced menstrual discomfort and treatment of hyperandrogenism among the most noted. Arguably, the back-to-back use of long-acting hormonal contraceptives, such as the intrauterine delivery systems, can be considered to be ‘permanent’ contraceptive alternatives to surgical sterilization. For surgical sterilization to become an attractive alternative, there is a tendency to combine sterilization with other procedures, such as endometrial ablation. The current geo-political climate is unfavorable with regards to family planning, and the antagonism between religion and the state continues to flare with every debate on the subject of contraception.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"23 1","pages":"285-294"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82536860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This overview focuses on the recent developments in the safety and efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) on established indications, namely contraception, treatment of heavy menstrual bleeding as well as endometrial protection during estrogen therapy for menopausal symptoms. The LNG-IUS is one of the most efficacious reversible contraceptive methods available. It can be used by various patient groups, including nulliparous women, during breast-feeding, after elective pregnancy termination, in women suffering from various pre-existing medical conditions and menopausal women. This review provides an overview of the published literature on the LNG-IUS from the last 5 years, focusing on cost–effectiveness, safety-related outcomes, the use of LNG-IUS by young and/or nulliparous women as well as by various different patient groups. After decades of dominance by the ‘the Pill’, it is likely that in the future, long-acting reversible contraceptives, such as the LNG-IUS, will becom...
{"title":"Safety and efficacy of the levonorgestrel-releasing intrauterine system: recent insights","authors":"K. Gemzell‐Danielsson, P. Inki, O. Heikinheimo","doi":"10.1586/EOG.13.18","DOIUrl":"https://doi.org/10.1586/EOG.13.18","url":null,"abstract":"This overview focuses on the recent developments in the safety and efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) on established indications, namely contraception, treatment of heavy menstrual bleeding as well as endometrial protection during estrogen therapy for menopausal symptoms. The LNG-IUS is one of the most efficacious reversible contraceptive methods available. It can be used by various patient groups, including nulliparous women, during breast-feeding, after elective pregnancy termination, in women suffering from various pre-existing medical conditions and menopausal women. This review provides an overview of the published literature on the LNG-IUS from the last 5 years, focusing on cost–effectiveness, safety-related outcomes, the use of LNG-IUS by young and/or nulliparous women as well as by various different patient groups. After decades of dominance by the ‘the Pill’, it is likely that in the future, long-acting reversible contraceptives, such as the LNG-IUS, will becom...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"25 1","pages":"235-247"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87607435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The surgical management of endometrial cancer has been markedly changed by minimally invasive techniques. After three decades of laparoscopy, robotic surgery has built upon and expanded the population of patients able to benefit from minimally invasive techniques. Updates in the field of laparoscopy continue, including single-site surgery. The emergence and rapid uptake of robotics continues to produce favorable outcomes while at the same time, expanding minimally invasive surgery to the obese and elderly populations. Sentinel lymph node detection and single-port surgery are expanding areas that will continue to push the role of minimally invasive surgery in endometrial cancer.
{"title":"Minimally invasive surgery in endometrial cancer: Recent updates","authors":"K. Doll, Anuj Suri, P. Gehrig","doi":"10.1586/EOG.13.14","DOIUrl":"https://doi.org/10.1586/EOG.13.14","url":null,"abstract":"The surgical management of endometrial cancer has been markedly changed by minimally invasive techniques. After three decades of laparoscopy, robotic surgery has built upon and expanded the population of patients able to benefit from minimally invasive techniques. Updates in the field of laparoscopy continue, including single-site surgery. The emergence and rapid uptake of robotics continues to produce favorable outcomes while at the same time, expanding minimally invasive surgery to the obese and elderly populations. Sentinel lymph node detection and single-port surgery are expanding areas that will continue to push the role of minimally invasive surgery in endometrial cancer.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"75 1","pages":"271-283"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73693748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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