Fertility and sterility最新文献

Ovarian stimulation (OS) has been the single most effective measure ever taken for enhancing assisted reproductive technology outcomes. In the past decade, we have seen a flurry of various new protocols used for OS in assisted reproductive technology In light of the important differences that characterize these new approaches for OS, we felt it was timely to review the relative merits of each and every new protocol.

Objective: To study the relationship between intensity of physical activity (PA) and semen quality in healthy young men.

Design: A prospective cohort study with repeated measures for each subject.

Patient(s): Healthy high school and university students who did not regularly smoke tobacco, drink alcohol, or take drugs or medicine, with normal body mass index and abdominal circumference.

Exposure: The participants underwent urologic visit, fasting blood and semen sampling, and anthropometric measurements, and filled in the International Physical Activity Questionnaire, at enrollment and after 4 and 8 months. Duration and frequency of walking, moderate-intensity, and vigorous-intensity activities in the last week were assessed, and a score was computed for total PA.

Main outcome measure(s): Semen specimens were taken at each visit through masturbation, after 3-5 days of abstinence, and analyzed by an expert urologist. Sperm concentration, total and progressive motility, and proportion of spermatozoa with normal morphology were measured. Linear and generalized linear mixed models with the Poisson family were fitted to assess the relationships between PA variables and sperm parameters, after adjusting for season, time, and study arm. The shape of the relationship was modeled through restricted cubic spline regression.

Result(s): A total of 143 male subjects, aged 18-23 years (median, 20 years), were enrolled. They had a median PA of 1,960 (95% confidence interval, 1,055-3,182) Metabolic Equivalent of Tasks in min/wk. Statistically significant differences were found for total, progressive motility, and percent of cell with normal morphology across categories of total PA; the highest medians of total (47%) and progressive motility (34%) and of the percentage of normal morphology cells (7%) were found for medium PA. Positive associations of sperm total motility and normal morphology with medium levels of PA, and negative associations with walking and vigorous-intensity activity emerged. Spline regression analysis confirmed these findings, showing an inverse U-shape relationship, with the highest value of total motility and normal morphology for medium PA, and the lowest values for lower and higher activity.

Conclusion(s): These findings support the present recommendations to practice moderate PA for health improvement, including semen quality.

Objective: To study cycle outcomes of women who choose to pursue oocyte cryopreservation, using published age-specific oocyte recommendations.

Design: Retrospective cohort.

Setting: Clinic.

Patient(s): A total of 5,915 patients seeking planned oocyte cryopreservation, 3,504 ultimately underwent ovarian stimulation with oocyte retrieval and cryopreservation, 425 of this cohort subsequently thawed with intent to use embryo transfer.

Exposure: Planned oocyte cryopreservation.

Main outcome measure(s): Planned oocyte cryopreservation consultation, fertility preservation cycle(s) and ovarian stimulation outcomes.

Result(s): A total of 5,915 women were seen in the initial consultation for planned fertility preservation (2012-2022). Ethnicity and the highest level of education were significant in predicting who would move forward with oocyte stimulation for fertility preservation. Women who reported working within the law and public policy and in the fields of health and medicine were statistically more likely to proceed with a cycle than those who listed other occupations. Of 3,504 women in the study cohort who underwent ovarian stimulation and egg retrieval, 1,331 (38.0%) achieved the age-based recommended number of oocytes to freeze. Only 57 (4.3%) of these women who met their age-based oocyte goal did so after their initial cryopreservation cycle. There was a significant association between ethnicity and number of cryopreservation cycles, specifically showing that Black or African American women were less likely to complete two or more cycles. Patients whose education background included graduate or professional degrees were more likely to have completed more than one cycle.

Conclusion(s): Self-identified ethnicity was significantly associated with the odds of moving forward with oocyte stimulation for fertility preservation and egg retrieval after initial consultation with ethnic minorities significantly less likely to continue treatment. Of those who undergo egg freezing, most women pursue more than one stimulation and cryopreservation cycle, yet the majority never meet their recommended number to freeze.

Objective: To evaluate population characteristics and obstetric complications after abdominal myomectomy vs. laparoscopic myomectomy.

Design: Retrospective cohort study.

Patient(s): A total of 13,868 and 338 pregnancies after abdominal or laparoscopic myomectomy, respectively.

Exposure: Obstetrics outcomes following abdominal and laparoscopic myomectomy were collected.

Main outcome measure(s): Obstetric outcomes after abdominal or laparoscopic myomectomies were collected using hospital discharges from 2004 to 2014 inclusively, and adjusted using multiple and binomial logistic regression in different models for age, obesity, chronic hypertension, and pregestational diabetes mellitus. Pregnancy, delivery, and neonatal outcomes were analyzed.

Result(s): Abdominal myomectomy were characterized by younger patients, lower rates of Caucasian, chronic hypertension, pregestational diabetes, active smoking, illicit drug use, and higher rates of previous cesarean delivery, and multiple gestations when compared with laparoscopic myomectomy. Pregnant women with laparoscopic myomectomy had decreased rates of pregnancy-induced hypertension (adjusted risk ratios [aRR], 0.12; 95% confidence intervals [CI], 0.006-0.24]), gestational hypertension (aRR, 0.24; 95% CI, 0.08-0.76), pre-eclampsia (aRR, 0.18; 95% CI, 0.07-0.48), and pre-eclampsia or eclampsia superimposed on chronic hypertension (aRR, 0.03; 95% CI, 0.005-0.3), gestational diabetes mellitus (aRR, 0.14; 95% CI, 0.06-0.34), preterm premature rupture of membranes (aRR, 0.14; 95% CI, 0.02-0.96), preterm delivery (aRR, 0.36; 95% CI, 0.23-0.55), and cesarean delivery (aRR, 0.01; 95% CI, 0.007-0.01) and small for gestational age (aRR, 0.15; 95% CI, 0.005-0.04), compared with abdominal myomectomy group. Laparoscopic myomectomy group had a higher rate of spontaneous (aRR, 35.57; 95% CI, 22.53-62.66), and operative vaginal delivery (aRR, 10.2; 95% CI, 8.3-12.56), uterine rupture (aRR, 6.1; 95% CI, 3.2-11.63), postpartum hemorrhage (aRR, 3.54; 95% CI, 2.62-4.8), hysterectomy (aRR, 7.74; 95% CI, 5.27-11.4), transfusion (aRR, 3.34; 95% CI, 2.54-4.4), pulmonary embolism (aRR, 7.44; 95% CI, 2.44-22.71), disseminated intravascular coagulation (aRR, 2.77; 95% CI, 1.47-5.21), maternal infection (aRR, 1.66; 95% CI, 1.1-2.5), death (aRR, 2.04; 95% CI, 1.31-3.2), and intrauterine fetal death (aRR, 2.99; 95% CI, 1.72-5.2) compared with the abdominal myomectomy group.

Conclusion(s): Women who had a previous abdominal myomectomy have underlying risk factors for hypertension disorders of pregnancy and gestational diabetes. Women who underwent laparoscopic myomectomies have higher risks of bleeding, uterine rupture, resultant complications, and death, and should be monitored as high-risk patients, like abdominal myomectomies.

Importance: Preimplantation genetic testing for aneuploidy (PGT-A) to deselect aneuploid embryos in assisted reproductive technology (ART) treatment cycles may hold promise by augmenting pregnancy rates per transfer and reducing pregnancy loss rates for patients with unexplained recurrent pregnancy loss (RPL).

Objective: To explore effectiveness of PGT-A in managing unexplained RPL by evaluating several key aspects: the likelihood of live birth in a subsequent spontaneous pregnancy, whether women with unexplained RPL have a higher rate of aneuploidy, whether euploid blastocysts offer comparable live birth rate (LBR) in patients with unexplained RPL, whether the endometrium is less selective in unexplained RPL loss, and whether PGT-A increases the LBR or reduces pregnancy losses until delivery.

Data sources: PubMed and Cochrane Library databases were searched from inception until June 2024.

Study selection and synthesis: Studies involving patients with ≥2 unexplained RPL who underwent ART with or without PGT-A or expectant management were included.

Main outcome measures: The primary outcome measure was the LBR. Secondary outcome measures were aneuploidy rate, clinical pregnancy rate, and clinical pregnancy loss rate.

Results: Whether couples with unexplained RPL have higher embryo aneuploidy rates remains equivocal. Euploid blastocyst transfers yielded comparable clinical pregnancy loss rate (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.57-2.13) and LBR (OR, 1.04; 95% CI, 0.74-1.44) in patients with and without unexplained RPL. Comprehensive chromosome analysis of products of conception shows similar aneuploidy rates between patients with and without RPL and does not support the less selective endometrium hypothesis. Preimplantation genetic testing for aneuploidy decreased clinical pregnancy loss rate (OR, 0.42; 95% CI, 0.27-0.67) and enhanced LBR per transfer (OR, 2.17; 95% CI, 1.77-2.65) and LBR per patient (OR, 1.85; 95% CI, 1.18-2.91) in patients with unexplained RPL.

Conclusion and relevance: Current low-quality evidence suggests that PGT-A enhances LBR per transfer and per patient in unexplained RPL. Well-designed randomized controlled trials comparing ART with PGT-A vs. expectant management for unexplained RPL are warranted.

Registration number: CRD42021291546.