Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.06.017
<div><h3>Objective</h3><div>To evaluate donor gamete utilization, patient satisfaction, and fertility treatment outcomes of patients pursuing treatment with donor gametes stratified by the desired race as well as ethnicity of the gamete donor.</div></div><div><h3>Design</h3><div>Survey study.</div></div><div><h3>Setting</h3><div>Clinic.</div></div><div><h3>Patient(s)</h3><div>Patients planning to undergo treatment using donor sperm and/or donor oocytes at a single academic fertility clinic in the Southeastern United States between 2015 and 2020.</div></div><div><h3>Intervention(s)</h3><div>None.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Utilization rates of donor gametes, satisfaction with donor gamete selection, and fertility treatment outcomes stratified by race and ethnicity of patient, as well as that of their gamete donor.</div></div><div><h3>Result(s)</h3><div>Four hundred fifty patients were eligible for inclusion and 170 (38%) responded to the survey. Among the respondents, 59% desired a non-Hispanic White gamete donor and 20% desired a non-Hispanic Black gamete donor. Patients seeking a non-Hispanic Black gamete donor had lower odds of using donor gametes (Odds ratio [OR], 0.13; 95% confidence interval [CI], 0.04–0.40) compared with individuals seeking a non-Hispanic White gamete donor. When evaluating satisfaction with donor gamete selection, patients seeking a non-Hispanic Black gamete donor reported lower satisfaction compared with individuals seeking a non-Hispanic White gamete donor (OR, 0.19; 95% CI, 0.09–0.43). When evaluating fertility outcomes, Non-Hispanic Black patients and those using non-Hispaninc Black gamete donors were found to have lower odds of successful conception compared with non-Hispanic White patients (OR, 0.18; 95% CI, 0.07–0.46) and individuals seeking non-Hispanic White gamete donors (OR, 0.26; 95% CI, 0.09–0.75), respectively.</div></div><div><h3>Conclusion(s)</h3><div>Patients seeking non-Hispanic Black donor gametes have lower utilization rates, less satisfaction with gamete donor selection, and lower odds of conception when compared with those seeking non-Hispanic White gamete donors. These findings highlight the need for more racial diversity within donor gamete banks, as well as within the donor pools available through agencies and fertility clinics.</div></div><div><div>Un estudio de encuesta evaluando tasas de utilización de gametos donados, satisfacción del paciente, y resultados de tratamientos de fertilidad de acuerdo a la raza y etnicidad deseada</div></div><div><h3>Objetivo</h3><div>Evaluar la utilización de los gametos donados, satisfacción del paciente, y los resultados de pacientes que siguen un tratamiento con donantes de gametos estratificados por la raza deseada así como la etnicidad del donante de gametos.</div></div><div><h3>Diseño</h3><div>Estudio de encuesta.</div></div><div><h3>Lugar</h3><div>Clínica.</div></div><div><h3>Paciente (s)</h3><div>Pacientes planeando seguir un trat
目的根据配子捐献者所希望的种族和民族，评估使用配子捐献者治疗的患者的配子捐献情况、患者满意度和生育治疗结果：调查研究 对象：2015年至2020年期间，计划在美国东南部一家学术性生殖诊所接受捐献精子和/或捐献卵细胞治疗的患者：按患者及其配子捐献者的种族和民族划分的捐献配子使用率、对捐献配子选择的满意度和生育治疗结果：共有 450 名患者符合调查条件，其中 170 人（38%）接受了调查。其中，59%的受访者希望获得非西班牙裔白人配子捐献者，20%希望获得非西班牙裔黑人配子捐献者。与寻求非西班牙裔白人配子捐献者相比，寻求非西班牙裔黑人配子捐献者的患者使用配子捐献者的几率较低（OR = 0.13，95% CI 0.04 - 0.40）。在评估配子捐献者选择满意度时，与寻求非西班牙裔白人配子捐献者的患者相比，寻求非西班牙裔黑人配子捐献者的患者满意度较低（OR 0.19，95% CI [0.09-0.43]）。在评估生育结果时发现，与非西班牙裔白人患者（OR=0.18，95% CI 0.07-0.46）和寻求非西班牙裔白人配子捐献者（OR=0.26，95% CI 0.09-0.75）相比，非西班牙裔黑人患者和利用非西班牙裔黑人配子捐献者成功受孕的几率较低：结论：与寻求非西班牙裔白人配子捐献者相比，寻求非西班牙裔黑人配子捐献者的患者利用率较低，对配子捐献者选择的满意度较低，受孕几率也较低。这些研究结果突出表明，配子捐献者库以及机构和生育诊所提供的捐献者库中需要更多的种族多样性。
{"title":"A survey study evaluating donor gamete utilization rates, patient satisfaction, and fertility treatment outcomes according to desired race and ethnicity","authors":"","doi":"10.1016/j.fertnstert.2024.06.017","DOIUrl":"10.1016/j.fertnstert.2024.06.017","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate donor gamete utilization, patient satisfaction, and fertility treatment outcomes of patients pursuing treatment with donor gametes stratified by the desired race as well as ethnicity of the gamete donor.</div></div><div><h3>Design</h3><div>Survey study.</div></div><div><h3>Setting</h3><div>Clinic.</div></div><div><h3>Patient(s)</h3><div>Patients planning to undergo treatment using donor sperm and/or donor oocytes at a single academic fertility clinic in the Southeastern United States between 2015 and 2020.</div></div><div><h3>Intervention(s)</h3><div>None.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Utilization rates of donor gametes, satisfaction with donor gamete selection, and fertility treatment outcomes stratified by race and ethnicity of patient, as well as that of their gamete donor.</div></div><div><h3>Result(s)</h3><div>Four hundred fifty patients were eligible for inclusion and 170 (38%) responded to the survey. Among the respondents, 59% desired a non-Hispanic White gamete donor and 20% desired a non-Hispanic Black gamete donor. Patients seeking a non-Hispanic Black gamete donor had lower odds of using donor gametes (Odds ratio [OR], 0.13; 95% confidence interval [CI], 0.04–0.40) compared with individuals seeking a non-Hispanic White gamete donor. When evaluating satisfaction with donor gamete selection, patients seeking a non-Hispanic Black gamete donor reported lower satisfaction compared with individuals seeking a non-Hispanic White gamete donor (OR, 0.19; 95% CI, 0.09–0.43). When evaluating fertility outcomes, Non-Hispanic Black patients and those using non-Hispaninc Black gamete donors were found to have lower odds of successful conception compared with non-Hispanic White patients (OR, 0.18; 95% CI, 0.07–0.46) and individuals seeking non-Hispanic White gamete donors (OR, 0.26; 95% CI, 0.09–0.75), respectively.</div></div><div><h3>Conclusion(s)</h3><div>Patients seeking non-Hispanic Black donor gametes have lower utilization rates, less satisfaction with gamete donor selection, and lower odds of conception when compared with those seeking non-Hispanic White gamete donors. These findings highlight the need for more racial diversity within donor gamete banks, as well as within the donor pools available through agencies and fertility clinics.</div></div><div><div>Un estudio de encuesta evaluando tasas de utilización de gametos donados, satisfacción del paciente, y resultados de tratamientos de fertilidad de acuerdo a la raza y etnicidad deseada</div></div><div><h3>Objetivo</h3><div>Evaluar la utilización de los gametos donados, satisfacción del paciente, y los resultados de pacientes que siguen un tratamiento con donantes de gametos estratificados por la raza deseada así como la etnicidad del donante de gametos.</div></div><div><h3>Diseño</h3><div>Estudio de encuesta.</div></div><div><h3>Lugar</h3><div>Clínica.</div></div><div><h3>Paciente (s)</h3><div>Pacientes planeando seguir un trat","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 856-865"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.07.008
<div><h3>Objective</h3><div>To evaluate the technical accuracy, inheritance, and pathogenicity of small copy number variants (CNVs) detected by a targeted next-generation sequencing–based preimplantation genetic testing for aneuploidy (PGT-A) platform.</div></div><div><h3>Design</h3><div>Retrospective observational study performed between 2020 and 2022.</div></div><div><h3>Setting</h3><div>Clinic.</div></div><div><h3>Patient(s)</h3><div>A total of 12,157 patients who underwent clinical PGT-A performed by targeted next-generation sequencing for whole chromosome and large segmental aneuploidies.</div></div><div><h3>Intervention(s)</h3><div>An incidental finding was reported when a CNV gain/loss of at least 3 consecutive amplicons appeared in at least 2 embryos from the same in vitro fertilization cycle.</div></div><div><h3>Main Outcome Measure(s)</h3><div>The primary outcome measures were the specificity, incidence, inheritance, and pathogenicity of small CNVs detected by the PGT-A platform. Accuracy of the PGT-A platform CNV calls was assessed via concordance with the CNV calls (size and genomic location) on chromosomal microarray of the gamete provider(s). Parental origin of the CNV and pathogenicity classifications were also reported.</div></div><div><h3>Result(s)</h3><div>An incidental finding that met reporting criteria was identified in 75 (0.62%; 95% confidence interval, 0.5%–0.8%) of 12,157 unique PGT-A patients. Chromosomal microarray follow-up was requested for all cases, and results were received for 1 or both members of 65 reproductive couples. In all cases, 1 of the gamete providers was confirmed to have the CNV identified in the embryos (100.0%, N = 65/65; 95% confidence interval, 94.5–100). The identified CNV was of maternal origin in 34 cases (52.3%) and of paternal origin in 31 cases (47.7%). A significant correlation was identified between PGT-A–predicted CNV sizes and chromosomal microarray detected sizes (r = 0.81) and genomic coordinates on parental deoxyribonucleic acid. Twenty-six (40%) of the CNVs were classified as benign/likely benign, 30 (46.2%) as a variant of uncertain significance, and 9 (13.8%) as pathogenic/likely pathogenic.</div></div><div><h3>Conclusion(s)</h3><div>Certain PGT-A platforms may enable the detection of inherited, small CNVs with extremely high specificity without prior knowledge of parental status. Most CNVs in this data set were confirmed to be benign/likely benign or a variant of uncertain significance. Pathogenic/likely pathogenic CNVs associated with a broad range of phenotypic features may also be detected, although a reliable negative predictive value for small CNVs with current PGT-A technologies is unknown because of the many technical challenges.</div></div><div><div>Confirmación y patogenicidad de pequeñas variaciones en el número de copias detectadas incidentalmente mediante una plataforma de pruebas genéticas preimplantacionales para aneuploidía basada en secuenciación de próxima generaci
{"title":"Confirmation and pathogenicity of small copy number variations incidentally detected via a targeted next-generation sequencing–based preimplantation genetic testing for aneuploidy platform","authors":"","doi":"10.1016/j.fertnstert.2024.07.008","DOIUrl":"10.1016/j.fertnstert.2024.07.008","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the technical accuracy, inheritance, and pathogenicity of small copy number variants (CNVs) detected by a targeted next-generation sequencing–based preimplantation genetic testing for aneuploidy (PGT-A) platform.</div></div><div><h3>Design</h3><div>Retrospective observational study performed between 2020 and 2022.</div></div><div><h3>Setting</h3><div>Clinic.</div></div><div><h3>Patient(s)</h3><div>A total of 12,157 patients who underwent clinical PGT-A performed by targeted next-generation sequencing for whole chromosome and large segmental aneuploidies.</div></div><div><h3>Intervention(s)</h3><div>An incidental finding was reported when a CNV gain/loss of at least 3 consecutive amplicons appeared in at least 2 embryos from the same in vitro fertilization cycle.</div></div><div><h3>Main Outcome Measure(s)</h3><div>The primary outcome measures were the specificity, incidence, inheritance, and pathogenicity of small CNVs detected by the PGT-A platform. Accuracy of the PGT-A platform CNV calls was assessed via concordance with the CNV calls (size and genomic location) on chromosomal microarray of the gamete provider(s). Parental origin of the CNV and pathogenicity classifications were also reported.</div></div><div><h3>Result(s)</h3><div>An incidental finding that met reporting criteria was identified in 75 (0.62%; 95% confidence interval, 0.5%–0.8%) of 12,157 unique PGT-A patients. Chromosomal microarray follow-up was requested for all cases, and results were received for 1 or both members of 65 reproductive couples. In all cases, 1 of the gamete providers was confirmed to have the CNV identified in the embryos (100.0%, N = 65/65; 95% confidence interval, 94.5–100). The identified CNV was of maternal origin in 34 cases (52.3%) and of paternal origin in 31 cases (47.7%). A significant correlation was identified between PGT-A–predicted CNV sizes and chromosomal microarray detected sizes (r = 0.81) and genomic coordinates on parental deoxyribonucleic acid. Twenty-six (40%) of the CNVs were classified as benign/likely benign, 30 (46.2%) as a variant of uncertain significance, and 9 (13.8%) as pathogenic/likely pathogenic.</div></div><div><h3>Conclusion(s)</h3><div>Certain PGT-A platforms may enable the detection of inherited, small CNVs with extremely high specificity without prior knowledge of parental status. Most CNVs in this data set were confirmed to be benign/likely benign or a variant of uncertain significance. Pathogenic/likely pathogenic CNVs associated with a broad range of phenotypic features may also be detected, although a reliable negative predictive value for small CNVs with current PGT-A technologies is unknown because of the many technical challenges.</div></div><div><div>Confirmación y patogenicidad de pequeñas variaciones en el número de copias detectadas incidentalmente mediante una plataforma de pruebas genéticas preimplantacionales para aneuploidía basada en secuenciación de próxima generaci","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 789-798"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.07.022
Shichao Cui Ph.D., Li Li M.D., Xingming Zhong Ph.D.
{"title":"A commentary on: “Association of serum uric acid with women’s ovarian reserve: observational study and Mendelian randomization analyses”","authors":"Shichao Cui Ph.D., Li Li M.D., Xingming Zhong Ph.D.","doi":"10.1016/j.fertnstert.2024.07.022","DOIUrl":"10.1016/j.fertnstert.2024.07.022","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Page 959"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.04.035
{"title":"When should assisted reproductive technology workups be performed: following a tiered approach or all on day 1?","authors":"","doi":"10.1016/j.fertnstert.2024.04.035","DOIUrl":"10.1016/j.fertnstert.2024.04.035","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 769-771"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.07.016
Qiaosong Han M.D. , Jinwei Hou M.D. , Zhengao Sun M.D., Ph.D.
{"title":"Seminal plasma exposure in in vitro fertilization cycles: “Dripping water hollows out stone, not through force but through persistence”","authors":"Qiaosong Han M.D. , Jinwei Hou M.D. , Zhengao Sun M.D., Ph.D.","doi":"10.1016/j.fertnstert.2024.07.016","DOIUrl":"10.1016/j.fertnstert.2024.07.016","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Page 957"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.08.347
Liam Kali B.A., C.M
Importance
Lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) families deserve evidence-based care within environments designed for their unique needs; however, care provided in fertility clinics has been reported to fall short, most notably for assigned female at birth recipients of therapeutic donor insemination (TDI).
Objective
To identify the aspects of routine infertility care that are clinically appropriate for this unique patient population, specifically those seeking pregnancy with donor sperm. The research question was posed, “What screening and treatment protocols are supported by the evidence regarding TDI care for LGBTQ+ families?”
Evidence Review
High quality, prospective studies specific to and/or inclusive of this patient population in assisted reproductive care contexts is limited, however evidence regarding age-informed prognosis, screening guidelines, treatment outcomes, insemination timing, number of inseminations per cycle, when to refer, and safety of the procedure were found.
Findings
Findings indicate that compared with routine infertility care protocols, a low-tech, low-intervention model of care for ovulatory LGBTQ+ individuals renders equal or higher success rates without increasing risk.
Conclusion
Given the current evidence, TDI for LGBTQ+ families can, with support and training, be provided appropriately in a variety of contexts, including community-based and primary care settings as well as in fertility clinics.
Relevance
This review establishes the current state of the evidence supporting TDI for LGBTQ+ families, expanding access to care for recipients as well as their care providers and outlining areas for further study.
{"title":"Therapeutic donor insemination for LGBTQ+ families: a systematic review","authors":"Liam Kali B.A., C.M","doi":"10.1016/j.fertnstert.2024.08.347","DOIUrl":"10.1016/j.fertnstert.2024.08.347","url":null,"abstract":"<div><h3>Importance</h3><div>Lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) families deserve evidence-based care within environments designed for their unique needs; however, care provided in fertility clinics has been reported to fall short, most notably for assigned female at birth recipients of therapeutic donor insemination (TDI).</div></div><div><h3>Objective</h3><div>To identify the aspects of routine infertility care that are clinically appropriate for this unique patient population, specifically those seeking pregnancy with donor sperm. The research question was posed, “What screening and treatment protocols are supported by the evidence regarding TDI care for LGBTQ+ families?”</div></div><div><h3>Evidence Review</h3><div>High quality, prospective studies specific to and/or inclusive of this patient population in assisted reproductive care contexts is limited, however evidence regarding age-informed prognosis, screening guidelines, treatment outcomes, insemination timing, number of inseminations per cycle, when to refer, and safety of the procedure were found.</div></div><div><h3>Findings</h3><div>Findings indicate that compared with routine infertility care protocols, a low-tech, low-intervention model of care for ovulatory LGBTQ+ individuals renders equal or higher success rates without increasing risk.</div></div><div><h3>Conclusion</h3><div>Given the current evidence, TDI for LGBTQ+ families can, with support and training, be provided appropriately in a variety of contexts, including community-based and primary care settings as well as in fertility clinics.</div></div><div><h3>Relevance</h3><div>This review establishes the current state of the evidence supporting TDI for LGBTQ+ families, expanding access to care for recipients as well as their care providers and outlining areas for further study.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 783-788"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reply of the authors: Seminal plasma exposure in IVF cycles: “dripping water hollows out stone, not through force but through persistence”","authors":"Susanne Liffner M.D., Ph.D., Gunilla Sydsjö Ph.D., Elizabeth Nedstrand M.D., Ph.D.","doi":"10.1016/j.fertnstert.2024.08.344","DOIUrl":"10.1016/j.fertnstert.2024.08.344","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Page 958"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.08.338
Luce A. Kassi M.D., Jennifer L. Eaton M.D., M.S.C.I.
{"title":"Fresh or frozen oocyte donation: is there a bad egg?","authors":"Luce A. Kassi M.D., Jennifer L. Eaton M.D., M.S.C.I.","doi":"10.1016/j.fertnstert.2024.08.338","DOIUrl":"10.1016/j.fertnstert.2024.08.338","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 821-822"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.06.016
<div><h3>Importance</h3><div>Menstruation serves as an indicator of women’s reproductive well-being and plays a pivotal role in their fertility; nevertheless, there remains an ongoing debate regarding the epidemiological evidence linking menstrual characteristics as well as fertility.</div></div><div><h3>Objective</h3><div>To explore the correlation between menstrual characteristics and fertility in women of reproductive age.</div></div><div><h3>Data Sources</h3><div>A comprehensive literature search was conducted using PubMed, Embase, Web of Science, and Cochrane libraries to identify research articles published up until February 9, 2024.</div></div><div><h3>Study Selection and Synthesis</h3><div><span>We included all studies in which the relationship between menstrual characteristics and pregnancy rates among women of reproductive age was investigated. We excluded studies involving the administration of </span>oral contraceptives<span>, the application of assisted reproductive technologies, and individuals with a documented history of infertility or partners with a known history of infertility.</span></div></div><div><h3>Main Outcome Measure(s)</h3><div>Clinical pregnancy and miscarriage.</div></div><div><h3>Result(s)</h3><div><span>This meta-analysis was composed of nine studies involving a total of 399,966 women, and the evidential quality derived from these studies was deemed to be high with a low risk of bias. Compared with a normal menstrual cycle<span> length (25–32 days), the impact of a short (<25 days) or long (>32 days) menstrual cycle on a woman’s pregnancy was relatively insignificant ([odds ratio {OR}, 0.81; 95% confidence interval {CI}, 0.65–1.01; I</span></span><sup>2</sup>, 68%]; [OR, 0.89; 95% CI, 0.75–1.06; I<sup>2</sup>, 60%], respectively); however, a change in cycle length may increase the risk of miscarriage ([relative risk, 1.87; 95% CI, 1.11–3.15; I<sup>2</sup>, 0]; [relative risk, 1.66; 95% CI, 1.07, 2.57; I<sup>2</sup><span>, 43%], respectively). In comparison to women experiencing menarche<span> at a typical age (12–14 years), those with a late age at menarche (>14 years) exhibited a decreased likelihood of pregnancy (OR, 0.92; 95% CI, 0.91–0.93; I</span></span><sup>2</sup><span>, 0%); and compared with women experiencing a normal duration of menstrual bleeding<span> (4–7 days), those with a short duration of menstrual bleeding (<4 days) exhibited reduced fertility potential (OR, 0.86; 95% CI, 0.84–0.88; I</span></span><sup>2</sup>, 29%).</div></div><div><h3>Conclusion(s)</h3><div>Short and long menstrual cycle lengths may elevate women’s susceptibility to spontaneous abortion, whereas late age at menarche as well as short duration of menstrual bleeding appear to be linked to diminished fertility among women of reproductive age.</div></div><div><h3>Clinical Trial Registration</h3><div>PROSPERO CRD42023487458 (9 December 2023).</div></div><div><div>La correlación entre las características menstruales y la f
{"title":"The correlation between menstrual characteristics and fertility in women of reproductive age: a systematic review and meta-analysis","authors":"","doi":"10.1016/j.fertnstert.2024.06.016","DOIUrl":"10.1016/j.fertnstert.2024.06.016","url":null,"abstract":"<div><h3>Importance</h3><div>Menstruation serves as an indicator of women’s reproductive well-being and plays a pivotal role in their fertility; nevertheless, there remains an ongoing debate regarding the epidemiological evidence linking menstrual characteristics as well as fertility.</div></div><div><h3>Objective</h3><div>To explore the correlation between menstrual characteristics and fertility in women of reproductive age.</div></div><div><h3>Data Sources</h3><div>A comprehensive literature search was conducted using PubMed, Embase, Web of Science, and Cochrane libraries to identify research articles published up until February 9, 2024.</div></div><div><h3>Study Selection and Synthesis</h3><div><span>We included all studies in which the relationship between menstrual characteristics and pregnancy rates among women of reproductive age was investigated. We excluded studies involving the administration of </span>oral contraceptives<span>, the application of assisted reproductive technologies, and individuals with a documented history of infertility or partners with a known history of infertility.</span></div></div><div><h3>Main Outcome Measure(s)</h3><div>Clinical pregnancy and miscarriage.</div></div><div><h3>Result(s)</h3><div><span>This meta-analysis was composed of nine studies involving a total of 399,966 women, and the evidential quality derived from these studies was deemed to be high with a low risk of bias. Compared with a normal menstrual cycle<span> length (25–32 days), the impact of a short (<25 days) or long (>32 days) menstrual cycle on a woman’s pregnancy was relatively insignificant ([odds ratio {OR}, 0.81; 95% confidence interval {CI}, 0.65–1.01; I</span></span><sup>2</sup>, 68%]; [OR, 0.89; 95% CI, 0.75–1.06; I<sup>2</sup>, 60%], respectively); however, a change in cycle length may increase the risk of miscarriage ([relative risk, 1.87; 95% CI, 1.11–3.15; I<sup>2</sup>, 0]; [relative risk, 1.66; 95% CI, 1.07, 2.57; I<sup>2</sup><span>, 43%], respectively). In comparison to women experiencing menarche<span> at a typical age (12–14 years), those with a late age at menarche (>14 years) exhibited a decreased likelihood of pregnancy (OR, 0.92; 95% CI, 0.91–0.93; I</span></span><sup>2</sup><span>, 0%); and compared with women experiencing a normal duration of menstrual bleeding<span> (4–7 days), those with a short duration of menstrual bleeding (<4 days) exhibited reduced fertility potential (OR, 0.86; 95% CI, 0.84–0.88; I</span></span><sup>2</sup>, 29%).</div></div><div><h3>Conclusion(s)</h3><div>Short and long menstrual cycle lengths may elevate women’s susceptibility to spontaneous abortion, whereas late age at menarche as well as short duration of menstrual bleeding appear to be linked to diminished fertility among women of reproductive age.</div></div><div><h3>Clinical Trial Registration</h3><div>PROSPERO CRD42023487458 (9 December 2023).</div></div><div><div>La correlación entre las características menstruales y la f","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 918-927"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.06.014
<div><h3>Objective</h3><div>To assess whether the provision of fertility treatment for patients with polycystic ovary syndrome (PCOS) varies by patient and physician-level demographic characteristics.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>University health system.</div></div><div><h3>Patient(s)</h3><div>Patients seeking care for PCOS and infertility from 2007–2021.</div></div><div><h3>Intervention(s)</h3><div>Patient age, body mass index, race, ethnicity, estimated household income, primary insurance payor, provider sex, and provider medical specialty.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Prescriptions for fertility treatment, including clomiphene citrate (CC), letrozole, and injectable gonadotropins. Differences in patient and physician demographics between patients who did as well as did not receive a prescription were identified with univariable analysis. Multilevel mixed-effects logistic regression was performed to determine associations between patient and physician demographics and prescription receipt.</div></div><div><h3>Result(s)</h3><div>A total of 3,435 patients with PCOS and infertility were identified, with a mean age of 31.1 ± 5.7 years. Of the 68.8% of patients who received a prescription, 47.8% of prescriptions were CC, 38.6% were letrozole, and 13.7% were injectable gonadotropins. There were lower odds of prescription receipt for Black patients compared with White patients (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.61–0.93), those with estimated household income below the federal poverty level compared with those above the national median (aOR, 0.71; 95% CI, 0.46–0.97), and those with public compared with commercial insurance (aOR, 0.53; 95% CI, 0.40–0.71). These disparities persisted in a subanalysis of patients prescribed oral medications only with lower odds of prescription receipt for Black compared with White patients (aOR, 0.74; 95% CI, 0.57–0.95), those with estimated household income below the federal poverty level compared with above the national median (aOR, 0.93; 95% CI, 0.87–0.98), and those with public compared with commercial insurance (aOR, 0.57; 95% CI, 0.42–0.76). Black patients waited, on average, 153.3 days longer than White patients, from the initial visit to the prescription receipt. Patients had lower odds of receiving any prescription from family medicine physicians (aOR, 0.36; 95% CI, 0.24–0.52) and general internal medicine physicians (aOR, 0.55; 95% CI, 0.42–0.73) compared with reproductive endocrinologists.</div></div><div><h3>Conclusion(s)</h3><div>Racial and socioeconomic disparities exist in the provision of infertility treatments for patients with PCOS. Fewer primary care physicians engaged in first-line fertility treatment, indicating an opportunity for physician education to improve access to fertility care.</div></div><div><div>Diferencias raciales y socioeconómicas en la prestación de tratamient
目的评估为多囊卵巢综合征（PCOS）患者提供的生育治疗是否因患者和医生的人口统计学特征而异：设计：回顾性队列研究：2007-2021年间在某大学医疗系统就诊的多囊卵巢综合征和不孕症患者：主要结果测量指标：生育治疗处方，包括枸橼酸氯米芬、来曲唑和注射用促性腺激素。通过单变量分析确定了开具处方与未开具处方的患者和医生在人口统计学方面的差异。为了确定患者和医生的人口统计学特征与接受处方之间的关系，进行了多层次混合效应逻辑回归：共发现 3435 名多囊卵巢综合征和不孕症患者，平均年龄为 31.1 +/- 5.7 岁。在68.8%收到处方的患者中，47.8%的处方为枸橼酸克罗米芬，38.6%为来曲唑，13.7%为注射用促性腺激素。黑人患者与白人患者相比（aOR 0.75，95% CI 0.61-0.93），估计家庭收入低于联邦贫困线（FPL）与高于全国中位数相比（aOR 0.71，95% CI 0.46-0.97），以及公共保险与商业保险相比（aOR 0.53，95% CI 0.40-0.71），接受处方的几率都较低。在一项仅针对口服药物处方患者的子分析中，这些差异依然存在：黑人患者获得处方的几率低于白人患者（aOR 0.74，95% CI 0.57-0.95）；估计家庭收入低于 FPL 而高于全国中位数（aOR 0.93，95% CI 0.87-0.98）；以及公共保险患者低于商业保险患者（aOR 0.57，95% CI 0.42-0.76）。黑人患者从初次就诊到拿到处方的平均时间比白人患者长 153.3 天。与生殖内分泌科医生相比，患者从家庭医生（aOR 0.36，95% CI 0.24-0.52）和普通内科医生（aOR 0.55，95% CI 0.42-0.73）处获得处方的几率较低：结论：在为多囊卵巢综合征患者提供不孕不育治疗方面存在种族和社会经济差异。参与一线不孕不育治疗的初级保健医生较少，这表明医生有机会通过教育来改善不孕不育治疗的可及性。
{"title":"Racial and socioeconomic disparities in fertility treatment provision for patients with polycystic ovary syndrome","authors":"","doi":"10.1016/j.fertnstert.2024.06.014","DOIUrl":"10.1016/j.fertnstert.2024.06.014","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether the provision of fertility treatment for patients with polycystic ovary syndrome (PCOS) varies by patient and physician-level demographic characteristics.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>University health system.</div></div><div><h3>Patient(s)</h3><div>Patients seeking care for PCOS and infertility from 2007–2021.</div></div><div><h3>Intervention(s)</h3><div>Patient age, body mass index, race, ethnicity, estimated household income, primary insurance payor, provider sex, and provider medical specialty.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Prescriptions for fertility treatment, including clomiphene citrate (CC), letrozole, and injectable gonadotropins. Differences in patient and physician demographics between patients who did as well as did not receive a prescription were identified with univariable analysis. Multilevel mixed-effects logistic regression was performed to determine associations between patient and physician demographics and prescription receipt.</div></div><div><h3>Result(s)</h3><div>A total of 3,435 patients with PCOS and infertility were identified, with a mean age of 31.1 ± 5.7 years. Of the 68.8% of patients who received a prescription, 47.8% of prescriptions were CC, 38.6% were letrozole, and 13.7% were injectable gonadotropins. There were lower odds of prescription receipt for Black patients compared with White patients (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.61–0.93), those with estimated household income below the federal poverty level compared with those above the national median (aOR, 0.71; 95% CI, 0.46–0.97), and those with public compared with commercial insurance (aOR, 0.53; 95% CI, 0.40–0.71). These disparities persisted in a subanalysis of patients prescribed oral medications only with lower odds of prescription receipt for Black compared with White patients (aOR, 0.74; 95% CI, 0.57–0.95), those with estimated household income below the federal poverty level compared with above the national median (aOR, 0.93; 95% CI, 0.87–0.98), and those with public compared with commercial insurance (aOR, 0.57; 95% CI, 0.42–0.76). Black patients waited, on average, 153.3 days longer than White patients, from the initial visit to the prescription receipt. Patients had lower odds of receiving any prescription from family medicine physicians (aOR, 0.36; 95% CI, 0.24–0.52) and general internal medicine physicians (aOR, 0.55; 95% CI, 0.42–0.73) compared with reproductive endocrinologists.</div></div><div><h3>Conclusion(s)</h3><div>Racial and socioeconomic disparities exist in the provision of infertility treatments for patients with PCOS. Fewer primary care physicians engaged in first-line fertility treatment, indicating an opportunity for physician education to improve access to fertility care.</div></div><div><div>Diferencias raciales y socioeconómicas en la prestación de tratamient","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 928-937"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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