Fertility and sterility最新文献

Objective: To study karyotypes of more than 8,200 oocyte donor candidates in nulliparous or multiparous women compared to a reference population.

Design: A retrospective observational multicentric study.

Subjects: The study included two cohorts of oocyte donor candidates recruited between January 2005 and October 2021: multiparous women with at least one child at the time of recruitment, and nulliparous women. Both were compared to a reference population composed of female newborns from literature.

Exposure: Not applicable.

Main outcome measures: Blood lymphocyte karyotype.

Results: A total of 8229 oocyte donor candidates from 22 fertility centers were included in this study. Nulliparous women (n=1890) and multiparous ones (n=6339) were compared to 8102 female newborns. Overall, 65 candidates were carriers of chromosomal abnormalities and were therefore excluded from the donation process (0.79%, 95% CI: 0.60-0.98). The occurrence of balanced structural chromosomal rearrangements was globally increased in the study population (0.49%, 95% CI: 0.34-0.64) compared to female newborns (0.24%, 95% CI: 0.34-0.64, p=0.0086). The number of reciprocal translocations was increased 5-fold in nulliparous oocyte donor candidates (0.37%, 95% CI: 0.10-0.64, p=0.013). The incidence of sex chromosome mosaicism was notably increased in multiparous oocyte donor candidates, with 17 cases (0.27%, 95% CI: 0.14-0.40, p=0.0052). Among chromosomal aberration carriers only two nulliparous women (one reciprocal translocation and one sex chromosome mosaicism) had fertility issues with a diagnosis of premature ovarian failure.

Conclusion: In this comprehensive 16-years French experience of karyotyping in oocyte donor candidates, we confirmed an increased incidence of balanced structural chromosomal rearrangements, especially among those without children at the time of recruitment. Karyotyping could be considered to identify any chromosomal abnormalities that may not be easily detectable through medical questioning. These abnormalities pose an inherent genetic risk for gamete recipients if left undetected.

Objective: To examine the association between sociodemographic factors and utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate.

Design: Retrospective cohort.

Setting: Academic-affiliated fertility center.

Subjects: Women presenting for initial infertility evaluation from January 2010-December 2021.

Exposure: Initial infertility evaluation and treatment utilization.

Main outcome measure(s): The prevalence of reproductive-aged women who reside in Massachusetts presenting for initial consult versus census-based estimates was calculated for each racial and ethnic group. Age at initial consult, insurance coverage, drive time to nearest affiliated center, and neighborhood deprivation as measured by Area Deprivation Index, were considered determinants of treatment utilization in regression analysis.

Result(s): A total of 16,160 women presenting for an infertility consult from 2010-2021 met inclusion criteria. Compared to census estimates, Non-Hispanic (NH) Asian and NH White individuals were overrepresented in initial consults, whereas the NH Black and Hispanic populations were underrepresented throughout the study period. Mean age at presentation was higher in NH Black women compared to the NH Asian reference group (35.7 ± 5.1 vs 34.6 ± 4.4 years old). A lower proportion of Hispanic and NH Black women had private insurance (78% and 79%, respectively) compared to 86% of NH Asian women. Over a fifth of Hispanic and NH Black women lived in the most disadvantaged ADI quintile (23 and 21%, respectively) compared to 6% of the reference population. Overall, the absence of private insurance, greater neighborhood disadvantage, and increased driving distance were associated with lower treatment utilization (OR 0.79, [95% confidence interval 0.71-0.87], for other vs. private insurance; OR 0.62, [0.53-0.72], for ADI quintile 5 vs. 1, OR 0.84 [0.72-0.97] for drive time 15-30 vs. <15 minutes), whereas age was not (OR 0.96 [0.93-1.00] for each 5-year increase).

Conclusion(s): Relative to their numbers in the broader population of reproductive-aged women in Massachusetts, the NH Black and Hispanic populations were the most underrepresented racial and ethnic groups seen for infertility evaluation at our center. These individuals were less likely to have private insurance coverage and more likely to live in disadvantaged neighborhoods, which are variables that negatively impact infertility treatment utilization.

Aromatase inhibitors, particularly letrozole, are now established as first-line ovulation induction agents, offering an effective ovarian stimulation strategy to enhance outcomes of intrauterine insemination. In recent years, they have also emerged as potentially valuable adjuvants to gonadotropin ovarian stimulation for IVF, particularly in fertility preservation in women with estrogen-responsive cancers. Their primary mechanism of action is to reduce circulating estrogen levels by inhibiting androgen aromatization. Recent studies have provided evidence that this property may confer therapeutic advantages in other patients undergoing IVF. In this article, evidence supporting the role of adjuvant letrozole in poor responders, as a moderator of OHSS symptoms, and an agent for improving the luteal phase after ovarian stimulation is reviewed. The use of letrozole for endometrial preparation in the frozen-thawed embryo transfer cycle is also considered.