Fertility and sterility最新文献

Importance: Patients with uterine factor infertility (UFI) have few options for family building. Uterus transplant is a feasible treatment for some patients; however, cost remains a significant concern.

Objective: To compare the cost effectiveness of treatment for patients with absolute uterine factor infertility to achieve 1-2 singleton births by gestational carrier or uterus transplant DESIGN: Decision analysis from the United States healthcare sector perspective, with time horizons to achieve one or two singleton births.

Intervention: Gestational carrier or uterus transplant MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios, comparing the costs (2020 U.S. Dollars) and effectiveness (quality-adjusted life years, QALYs, and live births) to achieve one or two births by gestational carrier and uterus transplant.

Results: In the base case of one singleton birth, the overall cost using a gestational carrier was $97,712.90 ($56,985.20-$153084.20) compared $116,137.20 ($67,142.88-$182,290.86) after uterus transplant. QALYs were higher in the gestational carrier arm (0.93) compared to uterus transplant (0.90) and overall rates of live birth were also higher in the gestational carrier arm (94%) compared to the uterus transplant arm (77%). Costs of the gestational carrier and uterus transplant recipient were the most significant cost variables in the model. Monte Carlo simulation showed that uterus transplant had a 37% chance of being the cost-effective strategy for a single live birth at a willingness to pay of $150,000/QALY. In the case of two singleton births, the cost using a gestational carrier was $186,278.56 ($103,597.81-$296,010.27) compared to $164,276.84 ($111,961.91-$229,394.43) after uterus transplant. QALYs were again higher in the gestational carrier arm (0.93) compared to uterus transplant (0.89). Overall rates of two live birth were also higher in the gestational carrier arm (86%) compared to the uterus transplant arm (66%). Monte Carlo simulation showed that uterine transplant has a 62% chance of being the cost-effective strategy for two live births at a willingness to pay of $150,000/QALY.

Conclusion: Treatment of uterine factor infertility with a gestational carrier is likely the most cost-effective approach for patients delivering a single child. However, the absolute costs associated uterus transplant were 14% less than a gestational carrier for those having two live singleton births.

ASRM develops evidence-based practice guidelines through a rigorous process of identifying clinically significant questions, conducting systematic literature reviews, and evaluating evidence quality. The evidence-based recommendations in ASRM practice guidelines provide reproductive healthcare professionals with standardized, scientifically grounded recommendations to enhance patient care.

Objective: To compare pregnancy outcomes and serum progesterone levels between women who took sublingual (SL) progesterone lozenges versus intramuscular (IM) progesterone-in-oil for endometrial preparation and luteal support in programmed frozen embryo transfer (pFET) cycles.

Design: Retrospective cohort study.

Subjects: All patients who underwent pFET of a single euploid good-quality blastocyst between January 2018 and April 2023 at a single fertility center.

Exposure: Patients received either compounded SL lozenges containing 200mg micronized progesterone three times per day or 50mg progesterone-in-oil daily. Both groups also took 100mg vaginal micronized progesterone three times per day.

Main outcome measures: Primary outcomes included clinical pregnancy (hCG ≥ 5 mIU/mL), ongoing pregnancy (pregnancy progressing past 8 weeks), live birth, and miscarriage. Secondary outcomes included progesterone levels at or one day prior to embryo transfer and at the time of the first pregnancy test.

Results: 1,951 pFET cycles were included, 1,030 (52.8%) who received IM progesterone and 921 (47.2%) who received SL progesterone. There were no significant differences between the IM and SL groups, respectively, in clinical pregnancy (69.5% vs. 74.4%, odds ratio (OR) 0.81, 95% confidence interval (CI) [0.61-1.09]), ongoing pregnancy (56.1% vs. 61.1%, OR 0.78, 95% CI [0.60-1.01]), live birth (50.1% vs. 57.0%, OR 0.85, 95% CI [0.64-1.14]), or miscarriage (25.1% vs. 24.1%, OR 1.24, 95% CI [0.87-1.79]) after controlling for age, race, estrogen preparation, endometrial thickness, physician performing the transfer, and number of prior embryo transfers (P>0.05, all). In the IM progesterone group, mean serum progesterone levels were significantly higher at the time of embryo transfer (41.6 ± 10.9 vs. 30.5 ± 15.7 ng/mL, P<0.01) and at first bhCG measurement (36.5 ± 11.5 vs. 29.4 ± 15.0 ng/mL, P<0.01) as compared to the SL group.

Conclusions: SL progesterone is a viable alternative to IM progesterone for pFET cycles that can minimize injection burden and likely improve patient satisfaction without compromising pregnancy outcomes. Progesterone levels, while slightly lower than the IM route, are in an acceptable range for luteal support.

Objective: To expand knowledge on physical outcomes and psychosocial experiences of oocyte donors after donation across 3 age cohorts.

Design: Cross-sectional mixed-methods survey.

Patients: A total of 363 participants (ages: 22-71 years, M = 38.8) recruited from Donor Sibling Registry and Facebook groups donated an average of 3.3 times, with 77.1% using nonidentified donation. Most were White (92.8%) and over half (59%) were married at the time of survey. Average length of time from initial donation to study participation was 13.75 years.

Exposure: Previous oocyte donation.

Main outcome measures: Self-reported physical outcomes and psychological experiences after donation.

Results: Most donors (89.5%) completing the online survey (N = 363) reported a positive overall experience. Self-reported physical outcomes, including changes to menstrual cycles, ovulation, or fertility, were reported by 21% of participants after donation. Many (41.4%) reported procedural pain, and 10.5% reported ovarian hyperstimulation syndrome. Anxiety (25.8%) and depression (23.2%) were the most common self-reported diagnoses. Validated measures (Patient Reported Outcomes Measurement Information System Bank V1.0 Depression, Patient Reported Outcomes Measurement Information System Bank V1.0 Anxiety) were used to assess mild or greater anxiety and depression (25.1% and 17.6%, respectively; t-score ≥55). Participants screened clinically significant rates of alcohol/drug misuse (11.5%; ≥2 Cut down, Annoyed, Guilty, Eye opener-Adapted to Include Drugs), with 50% of those reporting depressive symptoms. Anonymity was the most common qualitative response for reported emotional distress (17%) and regret (20%). Most participants (94.3%) reported no contact by clinics for medical updates after donation, despite 25% reporting they had changes in their health to communicate. Participants' open-ended responses detailed the 3 most important concerns: improved communication with clinics; desire for less anonymity; and more information on long-term donor health outcomes.

Conclusion: Most participants felt their oocyte donation experience was positive despite reported pain, menstrual cycle changes, and emotional distress. Depression and anxiety were the most common self-reported diagnoses. Depression rated higher than the national prevalence. Elevated Cut down, Annoyed, Guilty, Eye opener-Adapted to Include Drugs was associated with depression, indicating the importance of screening oocyte donors for mental health and drug/alcohol misuse. Concerns included lack of communication after procedure and lack of information provided on long-term health outcomes. Clinicians can incorporate these findings when counseling this population.

Objective: To study ferritin levels, and potential factors influencing them, in women with polycystic ovary syndrome (PCOS) and investigate potential associations between ferritin levels and other parameters in these women.

Design: Longitudinal general population-based cohort study, including data from both questionnaires and clinical measurements.

Subjects: The study was conducted with data from the participants of the Women's Health Study, including a total of 1,918 Finnish women aged approximately 35 years.

Exposure: Polycystic ovary syndrome was defined according to the Rotterdam criteria by the presence of at least 2 of the following findings: oligomenorrhea/amenorrhea, hyperandrogenism (clinical or biochemical), and polycystic ovarian morphology.

Main outcome measures: Serum ferritin levels and other parameters were determined from the cohort data, and the associations between ferritin levels and other investigated parameters were investigated with linear regression models.

Results: Women with PCOS had significantly higher median ferritin levels than those without PCOS (51.43 μg/L vs. 44.85 μg/L). Low ferritin levels were less common among women with PCOS who had oligomenorrhea or amenorrhea compared with those among women who did not (1.5% vs. 11.8%). The median ferritin levels were also found to be lower in hyperandrogenic women with PCOS than in those with normoandrogenemia (49.96 μg/L vs. 73.50 μg/L). Women with PCOS had higher fasting insulin levels than those without PCOS (8.85 mU/L vs. 7.60 mU/L), and a positive association between fasting insulin and ferritin levels was found in the whole population (effect size, 0.0619; 95% confidence interval, 0.005-0.119). Finally, associations between ferritin levels and history of infertility were investigated in both the total population and women with PCOS; however, no significant associations were found.

Conclusion: Our results suggest that women with PCOS have higher ferritin levels than those without PCOS and that both the decreased blood loss from irregular menstruation and increased androgen levels can influence ferritin levels in women with PCOS. A metabolic connection was also found because the serum insulin levels were associated positively with the serum ferritin levels in the total population, whereas the history of infertility did not seem to be associated with the serum ferritin levels in any of the study groups.