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Should physicians be facilitating gestational carrier arrangements in the absence of medical indication? 医生是否应该在没有医学指征的情况下促进妊娠载体的安排?
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.fertnstert.2024.11.013
Brian Levine M.D., M.S. , Alexis L. Cirel Esq. , Kate D. Schoyer M.D. , Arthur R. Derse M.D., J.D. , Robert T. Rydze M.D. , Eve C. Feinberg M.D.
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引用次数: 0
Target trial emulation of preconception serum vitamin D status on fertility outcomes: a couples-based approach 孕前血清维生素 D 状态对生育结果的目标试验模拟:基于夫妇的方法。
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.fertnstert.2024.08.332
Julia D. DiTosto M.S. , Ellen C. Caniglia Sc,.D. , Stefanie N. Hinkle Ph.D. , Naria Sealy B.A. , Enrique F. Schisterman Ph.D. , Erica Johnstone M.D. , Pauline Mendola Ph.D. , James Mills M.D. , Jim Hotaling M.D. , Ginny Ryan M.D. , Sunni L. Mumford Ph.D.
<div><h3>Objective</h3><div>To evaluate associations between preconception 25-hydroxyvitamin D (25(OH)D) levels and biomarkers in female and male partners on live birth (LB), pregnancy loss, and semen quality.</div></div><div><h3>Design</h3><div>Secondary analysis using the folic acid and zinc supplementation trial of couples seeking infertility treatment at four US centers (2013–2017). A target trial emulation framework was applied to estimate associations. Couples were observed for 9 months or through pregnancy.</div></div><div><h3>Subjects</h3><div>Couples seeking infertility treatment.</div></div><div><h3>Intervention(s)</h3><div>Preconception concentrations of 25(OH)D (primary) and associated biomarkers: vitamin D binding protein, calcium, free vitamin D, bioavailable vitamin D.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Live birth and pregnancy loss were ascertained via self-report and medical records. Semen quality was ascertained 6 months after enrollment. Log-binomial regression estimated risk ratios and 95% confidence intervals (CIs). Individual and joint models and effect measure modification by preconception body mass index were considered.</div></div><div><h3>Result(s)</h3><div>Among 2,370 couples, 19.5% of females and 29.9% of males were 25(OH)D deficient. Females with sufficient status had a 28%-higher likelihood of LB than deficient females (95% CI, 1.05–1.56). Female and male 25(OH)D status were associated with LB among those with normal body mass index (sufficient vs. deficient: female adjusted risk ratio [aRR], 1.39; 95% CI, 1.00–1.99; male aRR, 1.51; 95% CI, 1.01–2.25) and among obese female partners (sufficient vs. deficient: aRR, 1.33; 95% CI, 0.95–1.85). Couples whose both partners had higher 25(OH)D status had increased likelihood of LB (both not deficient vs. both deficient aRR, 1.26; 95% CI, 1.00–1.58). No associations were observed with pregnancy loss or semen quality. Similar results were found for all biomarkers except calcium.</div></div><div><h3>Conclusion(s)</h3><div>Preconception vitamin D status and bioavailability impact fertility among couples seeking infertility therapy, likely unrelated to semen quality. Body mass index stratified analyses demonstrated heterogeneous associations.</div></div><div><h3>Clinical Trial Registration Number</h3><div>NCT01857310.</div></div><div><div>Emulación de ensayos clínicos sobre el estado de vitamina D en suero preconcepcional y sus efectos sobre los resultados en la fertilidad: un enfoque basado en parejas.</div></div><div><h3>Objetivo</h3><div>Evaluar la asociación entre los niveles preconcepcionales de 25-hidroxivitamina D (25(OH)D) y los biomarcadores en mujeres y sus parejas varones con respecto al nacido vivo (LB), a la pérdida gestacional y a la calidad del semen.</div></div><div><h3>Diseño</h3><div>Análisis secundario del ensayo de suplementación con ácido fólico y zinc en parejas que buscaban tratamiento de infertilidad en cuatro centros de EE.UU. (2013-2017
目的:评估受孕前 25-羟基维生素 D(25(OH)D)与女性和男性伴侣的生物标志物对活产儿、妊娠损失和精液质量的影响:评估孕前25-羟基维生素D(25(OH)D)与女性和男性伴侣的生物标志物在活产、妊娠损失和精液质量方面的关联:利用FAZST试验对在美国4个中心寻求不孕症治疗的夫妇进行二次分析(2013-2017年)。采用目标试验仿真框架来估计相关性。对夫妇进行了为期九个月的随访,或随访至怀孕:主要结果测量指标:通过自我报告和医疗记录确定活产和流产情况。精液质量在入组 6 个月后确定。对数二项式回归估计风险比和 95% 置信区间 (CI)。研究考虑了个体模型和联合模型,以及受孕前体重指数(BMI)对影响测量的修正:在 2370 对夫妇中,19.5% 的女性和 29.9% 的男性缺乏 25(OH)D。25(OH)D充足的女性比25(OH)D缺乏的女性活产的几率高28%(95%CI 1.05-1.56)。在体重指数正常(充足与缺乏:女性 aRR 1.39,95%CI 1.00-1.99;男性 aRR 1.51,95%CI 1.01-2.25)和肥胖女性伴侣(充足与缺乏:aRR 1.33,95%CI 0.95-1.85)中,女性和男性 25(OH)D 状况与活产相关。夫妻双方的 25(OH)D 均较高的夫妇活产的可能性增加(双方均不缺乏 vs. 双方均缺乏:aRR 1.26,95%CI 1.00-1.58)。未观察到与妊娠损失或精液质量有任何关联。除了钙以外,所有生物标志物都有类似的结果:结论:孕前维生素 D 和生物利用度对寻求不孕不育治疗的夫妇的生育能力有影响,但可能与精液质量无关。BMI分层分析显示了不同的关联性。
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引用次数: 0
Criteria for the fellowship match: are we using the right parameters? 奖学金匹配的标准:我们是否使用了正确的参数?
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.fertnstert.2024.12.001
Ruben Alvero M.D. , Ruth B. Lathi M.D.
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引用次数: 0
Estrogen-progestins and endometriosis-associated depression: of causation, bias, and confounding.
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-31 DOI: 10.1016/j.fertnstert.2025.01.026
Noemi Salmeri, Sonia Cipriani, Paolo Vercellini
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引用次数: 0
How to monitor the efficacy of ovarian stimulation for assisted reproductive technology?
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-31 DOI: 10.1016/j.fertnstert.2025.01.027
Paul Pirtea, Jean Marc Ayoubi, Baris Ata
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引用次数: 0
Adding short duration GnRH antagonist and gonadotropin to natural cycle frozen embryo transfer allowed scheduling of transfer day without compromising live birth.
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-29 DOI: 10.1016/j.fertnstert.2025.01.022
Ali Borazjani, Kerry S J Flannagan, Jeanne E O'Brien, Phillip A Romanski, Micah Hill, Kate Devine

Objective: To determine if there is an association between the type of natural cycle frozen embryo transfer (natural cycle FET) [scheduled vs. traditional] and live birth outcomes.

Design: Retrospective cohort of all natural cycle FETs across a single network of fertility clinics in the United States SUBJECTS: All natural cycle FETs performed in ovulatory patients between January 2019 and April 2022 EXPOSURE: Scheduled natural cycle FET cycles received a short-duration of GnRH antagonist (1 amp per day) with low dose gonadotropins (75 IU/day) to delay ovulation to enable more flexible scheduling of the FET were compared with cycles without delay (natural cycle FET group).

Main outcome measure(s): Live birth RESULTS: There were a total of 1,087 natural cycle FETs that met inclusion criteria. The scheduled natural cycle FET protocol was utilized in 114 (10.5%) of these cycles. The mean age was 35 (interquartile range, IQR, 33-38). PGT-A was used in 76.3% (n=87) of scheduled natural cycle and 68.9% (n=670) of natural cycle FET cycles (p=0.11). The scheduled natural cycle FET group had a significantly higher estradiol level (318 vs. 249 pg/mL; p=0.0002) and a lower LH level (5.7 vs. 13.4 mIU/mL) at ovulatory trigger but a comparable peak endometrial thickness (9.4 vs. 9.7 mm) compared to the natural cycle FET group. Overall, there was a significant increase in positive hCG (scheduled natural cycle 81.6% vs natural cycle 64.3%; RR 1.26 (1.15-1.38)) and clinical pregnancy (scheduled natural cycle 68.4% vs natural cycle 57.1%; RR 1.21 (1.06-1.38)) in the scheduled natural cycle group. There was a higher proportion of live births in the scheduled natural cycle group, but this did not reach statistical significance (scheduled natural cycle 57.0% vs natural cycle 49.4%; RR 1.15 (0.97-1.36)). A sub-analysis of PGT-A cycles yielded similar results.

Conclusions: A scheduled natural cycle FET protocol using a short duration of GnRH antagonist along with low dose gonadotropin add-back did not reduce live birth compared to traditional natural cycle FET cycles. These results suggest that this is an alternative FET protocol that may serve as a viable strategy to provide flexibility in scheduling the day of FET while still allowing a patient to undergo a natural cycle protocol. This protocol modification may enable more clinics to offer natural cycle FET.

{"title":"Adding short duration GnRH antagonist and gonadotropin to natural cycle frozen embryo transfer allowed scheduling of transfer day without compromising live birth.","authors":"Ali Borazjani, Kerry S J Flannagan, Jeanne E O'Brien, Phillip A Romanski, Micah Hill, Kate Devine","doi":"10.1016/j.fertnstert.2025.01.022","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2025.01.022","url":null,"abstract":"<p><strong>Objective: </strong>To determine if there is an association between the type of natural cycle frozen embryo transfer (natural cycle FET) [scheduled vs. traditional] and live birth outcomes.</p><p><strong>Design: </strong>Retrospective cohort of all natural cycle FETs across a single network of fertility clinics in the United States SUBJECTS: All natural cycle FETs performed in ovulatory patients between January 2019 and April 2022 EXPOSURE: Scheduled natural cycle FET cycles received a short-duration of GnRH antagonist (1 amp per day) with low dose gonadotropins (75 IU/day) to delay ovulation to enable more flexible scheduling of the FET were compared with cycles without delay (natural cycle FET group).</p><p><strong>Main outcome measure(s): </strong>Live birth RESULTS: There were a total of 1,087 natural cycle FETs that met inclusion criteria. The scheduled natural cycle FET protocol was utilized in 114 (10.5%) of these cycles. The mean age was 35 (interquartile range, IQR, 33-38). PGT-A was used in 76.3% (n=87) of scheduled natural cycle and 68.9% (n=670) of natural cycle FET cycles (p=0.11). The scheduled natural cycle FET group had a significantly higher estradiol level (318 vs. 249 pg/mL; p=0.0002) and a lower LH level (5.7 vs. 13.4 mIU/mL) at ovulatory trigger but a comparable peak endometrial thickness (9.4 vs. 9.7 mm) compared to the natural cycle FET group. Overall, there was a significant increase in positive hCG (scheduled natural cycle 81.6% vs natural cycle 64.3%; RR 1.26 (1.15-1.38)) and clinical pregnancy (scheduled natural cycle 68.4% vs natural cycle 57.1%; RR 1.21 (1.06-1.38)) in the scheduled natural cycle group. There was a higher proportion of live births in the scheduled natural cycle group, but this did not reach statistical significance (scheduled natural cycle 57.0% vs natural cycle 49.4%; RR 1.15 (0.97-1.36)). A sub-analysis of PGT-A cycles yielded similar results.</p><p><strong>Conclusions: </strong>A scheduled natural cycle FET protocol using a short duration of GnRH antagonist along with low dose gonadotropin add-back did not reduce live birth compared to traditional natural cycle FET cycles. These results suggest that this is an alternative FET protocol that may serve as a viable strategy to provide flexibility in scheduling the day of FET while still allowing a patient to undergo a natural cycle protocol. This protocol modification may enable more clinics to offer natural cycle FET.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074431","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}
引用次数: 0
To trigger or surge: equal outcomes in modified and true natural frozen embryo transfer (FET) cycles.
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-29 DOI: 10.1016/j.fertnstert.2025.01.018
Blake Vessa, Thomas A Molinaro
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引用次数: 0
Will indocyanine green shed light on accessory cavitated uterine malformations?
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-28 DOI: 10.1016/j.fertnstert.2025.01.020
Christopher K Arkfeld, Alexandra Huttler, Victoria Fitz
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引用次数: 0
Universal karyotyping for oocyte donors: necessary safeguard or unnecessary expense?
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-28 DOI: 10.1016/j.fertnstert.2025.01.021
Daniela Diego, Heather S Hipp
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引用次数: 0
Key standards and principles for developing evidence-based clinical guidelines: balancing health professional, patient, funder, and government needs.
IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-28 DOI: 10.1016/j.fertnstert.2025.01.023
Chau Thien Tay, Anju E Joham, Helena J Teede

Clinical practice guidelines are critical tools to inform healthcare decision-making, yet development faces significant challenges in ensuring rigorous, reliable, and globally applicable recommendations. This review examines the essential standards and evolving approaches for creating high-quality, evidence-based guidelines that can effectively support clinical practice across diverse healthcare settings. Key standards for high-quality clinical practice guideline development emerge from leading global health organizations, emphasizing several critical components-establishing a multidisciplinary development group, defining a clear and relevant scope, conducting systematic evidence reviews and meta-analyses, and ensuring transparency throughout the development process. Innovative principles address emerging challenges such as research integrity assessment, incorporation of patient-centered methodologies, promotion of global collaborative approaches, and development of strategic implementation strategies. These evolving principles recognize the complex landscape of modern healthcare, where guidelines should adhere to rigorous standards to genuinely improve patient outcomes and encourage best practice care across diverse healthcare settings.

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Fertility and sterility
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