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Association between infertility and incident onset of systemic autoimmune rheumatic disease after childbirth: a population-based cohort study 不孕症与产后系统性自身免疫性风湿病发病之间的关系:一项基于人群的队列研究
IF 6.1 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-10 DOI: 10.1093/humrep/deae253
Natalie V Scime, Maria P Velez, May Y Choi, Joel G Ray, Alexa Boblitz, Hilary K Brown
STUDY QUESTION What is the association between infertility with or without fertility treatment and incident onset of systemic autoimmune rheumatic disease (SARD) among women who give birth? SUMMARY ANSWER Women who experienced infertility but did not use fertility treatment had a higher incidence of SARD up to 9 years after delivery than those who did not experience infertility, even after accounting for their higher rates of preeclampsia, spontaneous preterm birth, and stillbirth. WHAT IS KNOWN ALREADY Infertility is increasingly common and is an under-appreciated risk marker for chronic diseases in women. Despite several studies documenting abnormal immune activity in women with infertility, little is known about the association between infertility and incidence of autoimmune diseases such as SARD which disproportionately develops in reproductive-aged women. STUDY DESIGN, SIZE, DURATION This population-based cohort study using linked administrative data for all of ON, Canada, 2012–2021 and included 568 053 singleton births among 465 078 women aged 18–50 years without known pre-existing SARD. PARTICIPANTS/MATERIALS, SETTING, METHODS The exposures were: (i) no infertility with unassisted conception (referent [88.0% of the cohort]); (ii) infertility without fertility treatment (9.2%); (iii) infertility with non-invasive fertility treatment (ovulation induction or intrauterine insemination [1.4%]); and (iv) infertility with invasive fertility treatment (IVF or ICSI [1.4%]). SARD was identified by a validated algorithm based on diagnostic codes at two physician visits, one rheumatologist visit, or one hospitalization and measured from the index delivery date, with censoring at death, loss of health insurance, or study end of 31 March 2021. Marginal structural Cox proportional hazards models generated hazard ratios (HR) and 95% CIs representing total effects adjusted for sociodemographic characteristics, comorbidities, and smoking, and controlled direct effects additionally accounting for adverse pregnancy outcomes. MAIN RESULTS AND THE ROLE OF CHANCE The median (IQR) duration of follow-up was 6.5 (4–9) years. The incidence rate of SARD was 9.3 per 10 000 person-years in women without infertility, 12.5 per 10 000 person-years in those with infertility and no fertility treatment, 10.9 per 10 000 person-years following non-invasive fertility treatment, and 10.9 per 10 000 person-years after invasive fertility treatment. Infertility without treatment was associated with an elevated risk of SARD, even after accounting for adverse pregnancy outcomes (controlled direct effect HR 1.25, 95% CI 1.12–1.40). Neither non-invasive (total effect HR 1.06, 95% CI 0.79–1.42) nor invasive (total effect HR 0.97, 95% CI 0.69–1.36) fertility treatments were associated with SARD. LIMITATIONS, REASONS FOR CAUTION Exposure and outcome misclassification is possible as this study used published algorithms in health administrative data with unknown or imperfect sensitivity and
研究问题:在分娩妇女中,接受或不接受生育治疗的不孕症与全身性自身免疫性风湿性疾病(SARD)的发生率有何关联?不孕但未接受生育治疗的妇女在分娩后9年内的SARD发生率高于未接受不孕治疗的妇女,即使考虑到她们较高的先兆子痫、自发性早产和死胎发生率。不孕症越来越普遍,是女性慢性疾病的一个未被重视的风险标志。尽管有几项研究记录了不孕妇女的免疫活动异常,但人们对不孕与自身免疫性疾病(如SARD)发病率之间的关系知之甚少,SARD在育龄妇女中发病率很高。研究设计、规模、持续时间:这项基于人群的队列研究使用了2012-2021年加拿大安大略省所有相关行政数据,纳入了465 078名年龄在18-50岁、已知无SARD的单胎新生儿568 053名。参与者/材料、环境、方法暴露:(i)无无辅助受孕的不孕症(参考[占队列的88.0%]);(ii)未接受生育治疗的不孕症(9.2%);(iii)接受非侵入性生育治疗(促排卵或宫内人工授精[1.4%])的不孕症;(iv)有创生育治疗不孕症(IVF或ICSI[1.4%])。SARD通过基于两次医生就诊、一次风湿病医生就诊或一次住院的诊断代码的经过验证的算法进行识别,并从指标交付日期开始测量,在死亡、失去健康保险或研究结束于2021年3月31日时进行审查。边际结构Cox比例风险模型生成风险比(HR)和95% ci,代表经社会人口学特征、合并症和吸烟调整后的总效应,并控制直接效应,另外考虑不良妊娠结局。随访的中位(IQR)时间为6.5(4-9)年。无不孕妇女的SARD发病率为9.3 / 10000人年,有不孕且未接受生育治疗的妇女为12.5 / 10000人年,无创生育治疗后为10.9 / 10000人年,有创生育治疗后为10.9 / 10000人年。即使考虑了不良妊娠结局,未经治疗的不孕症仍与SARD风险升高相关(控制直接效应HR 1.25, 95% CI 1.12-1.40)。非侵入性(总效应HR 1.06, 95% CI 0.79-1.42)和侵入性(总效应HR 0.97, 95% CI 0.69-1.36)生育治疗均与SARD无关。由于本研究在卫生管理数据中使用了已发表的算法,敏感性和特异性未知或不完善,因此暴露和结果分类错误是可能的。个人层面的社会和生活方式因素以及不孕症的潜在原因的数据无法获得,因此未包括在分析中。研究结果的更广泛意义:在没有生育治疗的情况下,不孕可能是分娩妇女发生SARD的一个重要风险标志。提高保健提供者对不孕症妇女可能出现的SARD症状和相关妇科问题的认识,有助于在育龄期早期发现和治疗SARD。研究资金/竞争利益(S)本研究由加拿大卫生研究院通过Banting博士后奖学金到N.V.S.和加拿大研究主席到H.K.B.(2019-00158)资助,由ICES支持,由安大略省卫生部和长期护理部提供年度资助。本文所表达的分析、结论、观点和陈述仅代表作者的观点,不代表资助机构的观点;没有背书的意图,也不应该推断。资助者在考虑研究设计、数据收集、分析、解释、报告撰写或决定是否提交文章发表方面没有任何作用。M.Y.C.曾为Celltrion, Werfen, Organon, MitogenDx, AstraZeneca, Mallinckrodt Canada Inc .和Glaxo Smith Kline提供咨询服务。所有其他作者没有利益冲突。试验注册号n / a。
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引用次数: 0
Sphingolipids modulate redox signalling during human sperm capacitation. 鞘脂调节人类精子获能过程中的氧化还原信号。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-10 DOI: 10.1093/humrep/deae268
Steven Serafini, Cristian O'Flaherty
<p><strong>Study question: </strong>What role do sphingolipids have in mediating human sperm capacitation?</p><p><strong>Summary answer: </strong>Sphingosine 1-phosphate (S1P) mediates the acquisition of fertilizing competency in human spermatozoa by engaging with its Gi-coupled receptor S1PR1 and promoting production of reactive oxygen species such as nitric oxide and superoxide anion.</p><p><strong>What is known already: </strong>Bioactive sphingolipids, such as S1P, are fundamental for regulating numerous physiological domains and processes, such as cell membranes and signalling, cell death and proliferation, cell migration and invasiveness, inflammation, and central nervous system development.</p><p><strong>Study design, size, duration: </strong>Semen samples were obtained from a cohort of 10 healthy non-smoking volunteers (18-30 years old) to investigate the role of S1P in sperm.</p><p><strong>Participants/materials, setting, methods: </strong>Percoll-selected human spermatozoa were incubated at 37°C for 3.5 h in BWW media with or without foetal cord serum ultrafiltrate (FCSu), sphingosine (Sph), or ceramide (Cer). Spermatozoa were also incubated with or without pharmacological inhibitors of sphingolipid metabolism. Protein tyrosine phosphorylation was determined by immunoblotting. The acrosome reaction was determined by PSA-FTIC labelling of the acrosome and analysed using fluorescence microscopy. Intracellular nitric oxide (NO•) production was determined using a DAF-2DA probe. Immunocytochemistry was performed to localize and assess the functional relationship of key components of lipid signalling in spermatozoa. Sperm viability and motility of the samples were evaluated by the hypo-osmotic swelling (HOS) test and computer-aided sperm analysis (CASA). Statistical differences between groups were determined using ANOVA and Tukey's test. Normal distribution of the data and variance homogeneity were assessed using Shapiro-Wilk and Levene's test, respectively. A difference was considered significant when the P-value was ≤0.05.</p><p><strong>Main results and the role of chance: </strong>S1P mediates the acquisition of fertilizing competency in human spermatozoa by engaging with its Gi-coupled receptor S1PR1. We found that S1PR1 redistributes to the post-acrosomal region upon induction of capacitation. S1P signalling promotes the activation of the PI3K-AKT pathway, leading to NO• production during sperm capacitation. L-NAME, an nitric oxide synthase inhibitor, impaired the Sph- and Cer-dependent capacitation. Additionally, Sph and Cer promote superoxide anion (O2•-) production, and the extracellular addition of superoxide dismutase (SOD) prevented Sph- and Cer-dependent capacitation, suggesting that Sph and Cer stimulate O2•- production during sperm capacitation. Protein kinase type R (PKR), ceramide kinase (CERK), and protein kinase C (PKC) are responsible for translocating and activating sphingosine kinase 1 (SphK1), which is necessary to promo
研究问题:鞘脂在调节人类精子获能中起什么作用?摘要:sphingosin 1-phosphate (S1P)通过与其gi偶联受体S1PR1结合,促进一氧化氮和超氧阴离子等活性氧的产生,从而介导人类精子受精能力的获得。已知情况:生物活性鞘脂,如S1P,是调节许多生理领域和过程的基础,如细胞膜和信号传导、细胞死亡和增殖、细胞迁移和侵袭、炎症和中枢神经系统发育。研究设计、规模、持续时间:从10名健康的非吸烟志愿者(18-30岁)中获得精液样本,以研究S1P在精子中的作用。参与者/材料、环境、方法:percol选择的人精子在BWW培养基中37℃孵育3.5小时,含或不含胎脐带血清超滤液(FCSu)、鞘氨醇(Sph)或神经酰胺(Cer)。精子也在有或没有鞘脂代谢药理学抑制剂的情况下孵育。免疫印迹法测定蛋白酪氨酸磷酸化水平。顶体反应用PSA-FTIC标记法测定,荧光显微镜分析。采用DAF-2DA探针测定细胞内一氧化氮(NO•)的生成。免疫细胞化学用于定位和评估精子中脂质信号关键成分的功能关系。通过低渗透膨胀(HOS)试验和计算机辅助精子分析(CASA)评估精子活力和活力。采用方差分析和Tukey检验确定组间的统计学差异。数据的正态分布和方差齐性分别采用Shapiro-Wilk检验和Levene检验。p值≤0.05时差异被认为是显著的。主要结果和偶然性的作用:S1P通过与其gi偶联受体S1PR1结合介导人类精子受精能力的获得。我们发现S1PR1在诱导获能后重新分布到顶体后区域。S1P信号传导促进PI3K-AKT通路的激活,导致精子获能过程中NO•的产生。L-NAME,一种一氧化氮合酶抑制剂,损害了Sph和cer依赖的能化。此外,Sph和Cer促进了超氧阴离子(O2•-)的产生,细胞外超氧化物歧化酶(SOD)的添加阻止了Sph和Cer依赖的获能,这表明Sph和Cer在精子获能过程中刺激了O2•-的产生。蛋白激酶R (PKR)、神经酰胺激酶(CERK)和蛋白激酶C (PKC)负责鞘氨酸激酶1 (SphK1)的易位和激活,而SphK1是促进精子获能所需的S1P的产生所必需的。大规模数据:无。局限性,谨慎的原因:鞘脂的利用和作用可能在不同种类的精子中有所不同。研究结果的更广泛意义:鞘脂代谢产物如Sph、Cer、S1P和神经酰胺1-磷酸(C1P)在诱导人类精子获能中起着至关重要的作用。我们的研究为人类精子鞘脂的基本过程提供了新的见解,包括C1P在转运和激活SphK1中的重要性,以及S1P信号调节PI3K/AKT/NOS通路以产生NO•以使精子获能。我们是第一个在人类精子中发现PKR的存在及其在SphK1磷酸化活动和随后激活S1P信号中的作用。此外,我们的研究还发现S1PR1和S1PR3分别参与了能化和顶体反应。这些发现揭示了鞘脂驱动人类精子获能的新机制,并为进一步探索生物活性鞘脂代谢物在这一过程中的作用铺平了道路。最后,我们的研究为检查不育男性的脂质谱奠定了基础,因为潜在的差异会影响精子达到受精潜能的功能能力。研究经费/竞争利益:本研究由加拿大卫生研究院(CIHR)资助,资助号PJT-165962 to C.O.F. S.S.获得了muhc Desjardins奖学金。没有相互竞争的利益需要报告。
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引用次数: 0
Preterm birth in assisted reproduction: the mediating role of hypertensive disorders in pregnancy 辅助生殖中的早产:高血压疾病在妊娠中的中介作用
IF 6.1 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-10 DOI: 10.1093/humrep/deae261
Sindre Hoff Petersen, Bjørn Olav Åsvold, Deborah A Lawlor, Anja Pinborg, Anne Lærke Spangmose, Liv Bente Romundstad, Christina Bergh, Ulla-Britt Wennerholm, Mika Gissler, Aila Tiitinen, Ahmed Elhakeem, Signe Opdahl
STUDY QUESTION To what extent can hypertensive disorders in pregnancy (HDP) explain the higher risk of preterm birth following frozen embryo transfer (frozen-ET) and fresh embryo transfer (fresh-ET) in ART compared with naturally conceived pregnancies? SUMMARY ANSWER HDP did not contribute to the higher risk of preterm birth in pregnancies after fresh-ET but mediated 20.7% of the association between frozen-ET and preterm birth. WHAT IS KNOWN ALREADY Risk of preterm birth is higher after ART compared to natural conception. However, there is also a higher risk of HDP in pregnancies after ART compared to natural conception, in particular after frozen-ET. HDP increases the risk of both spontaneous and medically indicated preterm birth. It is not known to what extent the higher risk of preterm birth in ART-conceived pregnancies is mediated through HDP. STUDY DESIGN, SIZE, DURATION This registry-based cohort study included singleton pregnancies from the Committee of Nordic ART and Safety (CoNARTaS) cohort from Denmark (1994–2014), Norway (1988–2015), and Sweden (1988–2015). The analysis included 78 300 singletons born after fresh-ET, 18 037 after frozen-ET, and 4 426 682 after natural conception. The exposure was ART conception with either frozen-ET or fresh-ET versus natural conception. The main mediator of interest was any of the following HDP: gestational hypertension, preeclampsia, eclampsia, or chronic hypertension with superimposed preeclampsia. The main outcome was any preterm birth, defined as delivery &lt;37 weeks of gestation. Secondary outcomes were spontaneous and medically indicated preterm birth, and different severities of preterm birth based on the gestational age threshold. PARTICIPANTS/MATERIALS, SETTING, METHODS We linked data from the national Medical Birth Registries, ART registries/databases, and the National Patient Registries in each country using the unique national identity number of the mother. Criteria for inclusion were singleton pregnancies with birth order 1–4 in women aged ≥20 years at delivery. We used logistic regression to estimate odds ratios (ORs) with 95% CIs of preterm birth and decomposed the total effect into direct and mediated (indirect) effects to estimate the proportion mediated by HDP. Main models included adjustment for the year of delivery, maternal age, parity, and country. MAIN RESULTS AND THE ROLE OF CHANCE Pregnancies following frozen-ET had a higher risk of any preterm birth compared to natural conception (occurrence 6.6% vs 5.0%, total effect OR 1.29, 95% CI 1.21–1.37) and 20.7% of the association was mediated by HDP (mediated effect OR 1.05, 95% CI 1.04–1.05). The mediation occurred primarily in medically indicated preterm births. Pregnancies following fresh-ET also had a higher risk of any preterm birth compared to naturally conceived pregnancies (occurrence 8.1% vs 5.0%, total effect OR 1.49, 95% CI: 1.45–1.53), but none of this could be mediated by HDP (mediated effect OR 1.00, 95%CI 1.00–1.
研究问题:妊娠期高血压疾病(HDP)在多大程度上可以解释ART中冷冻胚胎移植(frozen- et)和新鲜胚胎移植(fresh- et)后早产风险高于自然妊娠的原因?HDP与新鲜et后妊娠的早产风险无关,但在冷冻et与早产之间介导了20.7%的关联。与自然受孕相比,人工受精后早产的风险更高。然而,与自然受孕相比,抗逆转录病毒治疗后怀孕发生HDP的风险也更高,尤其是冷冻体外受精后。HDP增加了自发早产和医学指示性早产的风险。目前尚不清楚HDP在多大程度上介导了art妊娠中较高的早产风险。这项基于登记的队列研究包括来自北欧艺术与安全委员会(CoNARTaS)丹麦(1994-2014)、挪威(1988-2015)和瑞典(1988-2015)的单胎妊娠。分析包括78 300例新鲜et后出生的单胎,18 037例冷冻et后出生的单胎,以及4 426 682例自然受孕后出生的单胎。暴露是ART受孕,冷冻et或新鲜et与自然受孕。主要感兴趣的中介是以下任何一种HDP:妊娠期高血压、子痫前期、子痫或慢性高血压合并子痫前期。主要结果是早产,定义为妊娠37周。次要结局是自发性早产和医学指示性早产,以及基于胎龄阈值的不同严重程度的早产。参与者/材料、环境、方法我们使用母亲的唯一国家身份号码将每个国家的国家医学出生登记处、ART登记处/数据库和国家患者登记处的数据联系起来。纳入标准为分娩时年龄≥20岁、出生顺序为1-4的单胎妊娠。我们使用逻辑回归来估计早产95% ci的优势比(or),并将总效应分解为直接效应和介导(间接)效应来估计HDP介导的比例。主要模型包括根据分娩年份、产妇年龄、胎次和国家进行调整。与自然受孕相比,冷冻体外受精后的偶发妊娠有更高的早产风险(发生率6.6% vs 5.0%,总效应OR 1.29, 95% CI 1.21-1.37), 20.7%的关联是由HDP介导的(介导效应OR 1.05, 95% CI 1.04-1.05)。这种调解主要发生在医学上指征的早产中。与自然妊娠相比,新鲜et妊娠也有更高的早产风险(发生率8.1% vs 5.0%,总效应OR 1.49, 95%CI: 1.45-1.53),但这些都不能由HDP介导(介导效应OR 1.00, 95%CI 1.00 - 1.00,比例介导0.5%)。敏感性分析加上额外的混杂因素调整,如体重指数和吸烟,以及对初产妇女的限制,与我们的主要发现一致。此外,结果不是由ART程序的差异(卵胞浆内单精子注射,培养时间或转移的胚胎数量)驱动的。虽然我们可以调整一些重要的混杂因素,但我们不能排除残留的混杂因素,特别是与不孕症相关的因素。这项以人群为基础的中介分析表明,ART治疗后早产风险较高的部分原因可能是冷冻et治疗后HDP风险较高。如果建立了因果关系,可能需要对冷冻et后怀孕的预防性策略进行调查,如预防性阿司匹林。研究资金/竞争利益(S)资金由NordForsk(项目编号:71450)、北欧妇产科联合会(项目编号:NF13041、NF15058、NF16026和NF17043)、挪威科技大学(项目编号:81850092)、ESHRE生殖医学研究补助金(赠款编号:2022-2)和挪威卓越中心资助计划研究理事会(项目编号:262700)提供。D.A.L和a.e.对这项工作的贡献得到了欧洲研究理事会在欧盟地平线2020研究和创新计划(资助协议号101021566)和英国医学研究理事会(MC_UU_00032/05)下的支持。D.A.L.已经得到罗氏诊断公司和美敦力有限公司的支持,用于与这里介绍的研究无关的研究。Pinborg宣布了Gedeon Richter、Ferring、Cryos和Merck的资助,IBSA、Ferring、Gedeon Richter、Cryos和Merck的咨询费,Gedeon Richter、Ferring、Merck和Organon的付款,Gedeon Richter的旅行支持。
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引用次数: 0
Adolescent menstrual cycle pattern, body mass index, endocrine and ovarian ultrasound characteristics of PCOS and future fertility, cardiovascular-, and metabolic health: a 25-year longitudinal follow-up study 青春期月经周期模式、体重指数、内分泌和卵巢超声特征与多囊卵巢综合征的未来生育、心血管和代谢健康:一项25年的纵向随访研究
IF 6.1 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-10 DOI: 10.1093/humrep/deae262
Machiel H A van Hooff, Mirte R Caanen, Henrike E Peters, Joop S E Laven, Cornelis B Lambalk
STUDY QUESTION What is the predictive value of oligomenorrhea and other PCOS diagnostic characteristics in adolescence (age 15–18 years) for future fertility and cardiovascular and metabolic health at adult age? SUMMARY ANSWER Adolescents with oligomenorrhea are more often treated to conceive but are as likely to have as much children as those with regular periods, while persisting oligomenorrhea may associate more often with cardiovascular or metabolic problems. WHAT IS KNOWN ALREADY Adolescents with oligomenorrhea have a high risk for adult PCOS associated with subfertility due to ovulatory disorders and long-term health risks. Longitudinal studies to estimate the extent of these risks with input starting at adolescence and covering the complete reproductive lifespan are lacking. STUDY DESIGN, SIZE, DURATION A 25-year prospective follow-up study based on a unique population-based adolescent study on menstrual irregularities performed between 1990 and 1997, the Pubertal Onset of Menstrual Cycle abnormalities, a Prospective study (POMP study). Of the 271 invited adults, 160 (59%) participated. PARTICIPANTS/MATERIALS, SETTING, METHODS We contacted stratified samples of the POMP study cohort two decades after the initial study for a questionnaire assessing PCOS features, fertility history, pregnancy outcome, metabolic, and cardiovascular health. One hundred and sixty subjects completed the questionnaire. The mean adolescent age was 15.3 years, and the women were 39.6 years at the time of follow-up. One hundred and eight subjects had a regular menstrual cycle as adolescents and 52 were oligomenorrheic. MAIN RESULTS AND THE ROLE OF CHANCE Of those with adolescent regular menstrual cycles 12 never tried to conceive, 4 tried but never conceived and 92 of 96 (96%) conceived, 89 of 96 (93%) delivering at least one living child. The median number of children was two. The mean time to pregnancy (TTP) was 8.4 months in the women with regular periods as adolescents and 13.2 months in case of oligomenorrhea (P = 0.08) and subfertility was present in respectively 18% and 26%. 47 of 52 adolescents with oligomenorrhea tried to conceive and 45 succeeded to have at least one live birth. Twenty-eight per cent of the subjects reported a change over time of their menstruation pattern. Fifty per cent of the girls with adolescent oligomenorrhea developed a regular cycle and 16% of those with regular periods changed to oligomenorrhea with significantly more reported subfertility (40%, P = 0.04). In case of persistent oligomenorrhea, a significant proportion (40%) underwent fertility treatment (P = 0.04). Adult BMI did not differ between groups. The risk for pregnancy-induced hypertension or pre-eclampsia was comparable between the groups. Gestational diabetes developed in three subjects each with persistent oligo amenorrhea. Adult diabetes, hypertension, and hypercholesterolemia were also mostly reported in case of persistent oligomenorrhea. In this group, the prevalenc
青春期(15-18岁)少月经和其他多囊卵巢综合征的诊断特征对成年后的生育能力和心血管和代谢健康有什么预测价值?经期少的青少年更常接受怀孕治疗,但与经期正常的青少年生育的孩子数量一样多,而持续经期少的青少年可能更多地伴有心血管或代谢问题。青春期少经患者由于排卵障碍和长期健康风险,有较高的与低生育能力相关的成年PCOS风险。缺乏纵向研究来估计这些风险的程度,从青春期开始投入,覆盖整个生殖寿命。研究设计、规模、持续时间一项基于1990年至1997年间一项独特的以人群为基础的青少年月经不规律研究,即青春期开始的月经周期异常,一项前瞻性研究(POMP研究)。在271名被邀请的成年人中,160人(59%)参加了活动。参与者/材料、环境、方法我们接触了POMP研究队列20年后的分层样本,对PCOS特征、生育史、妊娠结局、代谢和心血管健康进行问卷调查。160名受试者完成了问卷调查。随访时,青少年平均年龄为15.3岁,女性平均年龄为39.6岁。108名受试者在青少年时期月经周期正常,52名受试者少经血。在青春期月经周期正常的妇女中,12例从未尝试怀孕,4例尝试但未怀孕,96例中有92例(96%)怀孕,96例中有89例(93%)分娩至少一个活婴。孩子的中位数是两个。月经正常的青少年女性平均妊娠时间为8.4个月,月经少的女性平均妊娠时间为13.2个月(P = 0.08),生育能力低下的分别为18%和26%。52名月经少的青少年中有47人试图怀孕,45人成功至少活产一次。28%的受试者报告说,随着时间的推移,她们的月经模式发生了变化。50%的青春期经期少月经的女孩有了规律的月经周期,而16%的经期正常的女孩变成了经期少月经,她们的生育能力明显下降(40%,P = 0.04)。对于持续性少经患者,接受生育治疗的比例显著(40%)(P = 0.04)。成人BMI在两组之间没有差异。妊娠高血压或先兆子痫的风险在两组之间具有可比性。妊娠期糖尿病发生在三个受试者中,每个受试者都有持续性少闭经。成人糖尿病、高血压和高胆固醇血症也多见于持续性少月经。在这一组中,心血管和代谢问题的患病率为14%,而在青春期月经周期正常的情况下,这一比例为7%。局限性,谨慎的理由研究中的数量很少。然而,青春期经期少经患者与青春期月经周期正常的患者中至少有一个孩子的比例之间的微小差异令人放心。妊娠期数据可能因早期治疗少出血成人而有偏差。研究结果的更广泛意义少经期青少年可以放心,他们活产的机会与月经周期正常的青少年相当。研究资金/竞争利益(S)本研究未获得外部资金,J.S.E.L.从以下公司(按字母顺序排列)获得无限制的研究资助:Ansh实验室、Ferring、默克和罗氏诊断。他从安什实验室、Art pred、Ferring、Gedeon Richter和罗氏诊断公司获得了咨询费或版税。他从费林和罗氏诊断公司获得了演讲费,并获得了费林和罗氏诊断公司参加会议和/或旅行的支持,他还参加了LOCI Trial UK的咨询委员会。试验注册号荷兰试验注册处,NTR5871。
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引用次数: 0
The web-based Pleasure&Pregnancy programme in the treatment of unexplained infertility: a randomized controlled trial. 基于网络的 "快乐与怀孕 "计划在治疗不明原因不孕症中的应用:随机对照试验。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1093/humrep/deae220
F Dreischor, E A F Dancet, C B Lambalk, H W van Lunsen, D Besselink, J van Disseldorp, J Boxmeer, E A Brinkhuis, B J Cohlen, A Hoek, M de Hundt, C A H Janssen, M Lambers, J Maas, A Nap, D Perquin, M Verberg, H R Verhoeve, J Visser, L van der Voet, M H Mochtar, M Goddijn, E Laan, M van Wely, I M Custers
<p><strong>Study question: </strong>Does offering the Pleasure&Pregnancy (P&P) programme rather than expectant management improve naturally conceived ongoing pregnancy rates in couples diagnosed with unexplained infertility?</p><p><strong>Summary answer: </strong>The P&P programme had no effect on the ongoing pregnancy rates of couples with unexplained infertility.</p><p><strong>What is known already: </strong>Underpowered studies suggested that face-to-face interventions targeting sexual health may increase pregnancy rates. The impact of an eHealth sexual health programme had yet to be evaluated by a large randomized controlled trial.</p><p><strong>Study design, size, duration: </strong>This is a nationwide multi-centre, unblinded, randomized controlled superiority trial (web-based randomization programme, 1:1 allocation ratio). This RCT intended to recruit 1164 couples within 3 years but was put on hold after having included 700 couples over 5 years (2016-2021). The web-based P&P programme contains psychosexual information and couple communication, mindfulness and sensate focus exercises aiming to help maintain or improve sexual health, mainly pleasure, and hence increase pregnancy rates. The P&P programme additionally offers information on the biology of conception and enables couples to interact online with peers and via email with coaches.</p><p><strong>Participants/materials, setting, methods: </strong>Heterosexual couples with unexplained infertility and a Hunault-prognosis of at least 30% chance of naturally conceiving a live-born child within 12 months were included, after their diagnostic work-up in 41 Dutch secondary and tertiary fertility centres. The primary outcome was an ongoing pregnancy, defined as a viable intrauterine pregnancy of at least 12 weeks duration confirmed by an ultrasound scan, conceived naturally within 6 months after randomization. Secondary outcomes were time to pregnancy, live birth, sexual health, and personal and relational well-being at baseline and after 3 and 6 months. The primary analyses were according to intention-to-treat principles. We calculated relative risks (RRs, pregnancy rates) and a risk difference (RD, pregnancy rates), Kaplan-Meier survival curves (live birth over time), and time, group, and interactive effects with mixed models analyses (sexual health and well-being).</p><p><strong>Main results and the role of chance: </strong>Totals of 352 (one withdrawal) and 348 (three withdrawals) couples were allocated to, respectively the P&P group and the expectant management group. Web-based tracking of the intervention group showed a high attrition rate (57% of couples) and limited engagement (i.e. median of 16 visits and 33 min total visitation time per couple). Intention-to-treat analyses showed that 19.4% (n = 68/351) of the P&P group and 22.6% (n = 78/345) of the expectant management group achieved a naturally conceived ongoing pregnancy (RR = 0.86; 95% CI = 0.64-1.15, RD = -3.24%; 95% CI -9.28 t
研究问题:提供 "快乐怀孕"(P&P)计划而非预期管理是否能提高被诊断为不明原因不孕症夫妇的自然怀孕率?P&P计划对不明原因不孕症夫妇的持续怀孕率没有影响:研究表明,针对性健康的面对面干预可能会提高怀孕率。研究的设计、规模和持续时间:这是一项全国范围的多中心、无盲、随机对照优效试验(基于网络的随机方案,1:1 分配比例)。该 RCT 原计划在 3 年内招募 1164 对夫妇,但在 5 年内(2016-2021 年)招募了 700 对夫妇后被搁置。基于网络的 P&P 计划包含性心理信息和夫妻沟通、正念和感觉集中练习,旨在帮助维持或改善性健康,主要是性快感,从而提高怀孕率。此外,P&P 计划还提供了受孕生物学方面的信息,并使夫妇能够在线与同伴互动,或通过电子邮件与教练互动。参与者/材料、环境、方法:41 家荷兰二级和三级生殖中心对不明原因不孕症夫妇进行诊断后,将他们纳入其中,并预测他们在 12 个月内自然怀上活产婴儿的几率至少为 30%。主要结果是持续妊娠,即经超声波扫描确认的至少12周的宫内存活妊娠,并在随机化后6个月内自然受孕。次要结果是怀孕时间、活产率、性健康以及基线和 3 个月及 6 个月后的个人和关系幸福感。主要分析遵循意向治疗原则。我们计算了相对风险(RRs,怀孕率)和风险差异(RD,怀孕率)、卡普兰-米尔生存曲线(活产时间)以及混合模型分析的时间、组别和交互效应(性健康和幸福感):共有 352 对(退出 1 对)和 348 对(退出 3 对)夫妇分别被分配到 P&P 组和预期管理组。对干预组的网络跟踪显示,该组的减员率较高(57%的夫妇),参与度有限(即每对夫妇的访问次数中位数为 16 次,总访问时间为 33 分钟)。意向治疗分析显示,19.4% 的 P&P 组(n = 68/351)和 22.6%的预期管理组(n = 78/345)实现了自然受孕(RR = 0.86;95% CI = 0.64-1.15,RD = -3.24%;95% CI -9.28-2.81)。两组的怀孕时间没有差异(对数等级 = 0.23)。P&P组中有18.8%的夫妇(n = 66/351)生下了活产儿,而预期管理组中有22.3%的夫妇(n = 77/345)生下了活产儿(RR = 0.84; 95% CI = 0.63-1.1)。随着时间的推移,两组的性交频率同样有所下降。P&P组女性的性快感、性高潮和满意度有所提高,而预期管理组的这些结果保持稳定。男性的性高潮、性交满意度和总体满意度则随着时间的推移而下降,组间没有差异。干预措施没有影响个人和人际关系的幸福感。在整个研究人群中,因过早开始医学辅助生殖而导致的不依从率和临床随访损失率分别为15.1%和1.4%。按方案进行的主要结果分析表明,两组之间没有差异。将参与度最高的使用者与预期管理组进行比较后发现,干预组的同房频率下降较少,男性性欲有所提高:由于招募速度较慢,未能达到 1164 个样本的预期规模。然而,已达到的样本量足够大,足以排除P&P计划对我们的主要结果有超过8%的改善:研究结果的广泛影响:P&P 计划不应该用来提高自然怀孕率,但可以考虑用来改善性健康。P&P项目的自然减员和有限参与与其他电子健康项目的研究结果一致,并强调了用户体验研究的重要性:由荷兰卫生研究与发展组织(ZonMw,编号:843001605)和佛兰德斯研究基金会资助。C.B.L. 是《人类生殖》杂志的主编。H.W.L. 从 Prometheus Publishers Springer Media Thieme Verlag 获得版税或许可证。J.B.
{"title":"The web-based Pleasure&Pregnancy programme in the treatment of unexplained infertility: a randomized controlled trial.","authors":"F Dreischor, E A F Dancet, C B Lambalk, H W van Lunsen, D Besselink, J van Disseldorp, J Boxmeer, E A Brinkhuis, B J Cohlen, A Hoek, M de Hundt, C A H Janssen, M Lambers, J Maas, A Nap, D Perquin, M Verberg, H R Verhoeve, J Visser, L van der Voet, M H Mochtar, M Goddijn, E Laan, M van Wely, I M Custers","doi":"10.1093/humrep/deae220","DOIUrl":"10.1093/humrep/deae220","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study question: &lt;/strong&gt;Does offering the Pleasure&Pregnancy (P&P) programme rather than expectant management improve naturally conceived ongoing pregnancy rates in couples diagnosed with unexplained infertility?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary answer: &lt;/strong&gt;The P&P programme had no effect on the ongoing pregnancy rates of couples with unexplained infertility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known already: &lt;/strong&gt;Underpowered studies suggested that face-to-face interventions targeting sexual health may increase pregnancy rates. The impact of an eHealth sexual health programme had yet to be evaluated by a large randomized controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design, size, duration: &lt;/strong&gt;This is a nationwide multi-centre, unblinded, randomized controlled superiority trial (web-based randomization programme, 1:1 allocation ratio). This RCT intended to recruit 1164 couples within 3 years but was put on hold after having included 700 couples over 5 years (2016-2021). The web-based P&P programme contains psychosexual information and couple communication, mindfulness and sensate focus exercises aiming to help maintain or improve sexual health, mainly pleasure, and hence increase pregnancy rates. The P&P programme additionally offers information on the biology of conception and enables couples to interact online with peers and via email with coaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants/materials, setting, methods: &lt;/strong&gt;Heterosexual couples with unexplained infertility and a Hunault-prognosis of at least 30% chance of naturally conceiving a live-born child within 12 months were included, after their diagnostic work-up in 41 Dutch secondary and tertiary fertility centres. The primary outcome was an ongoing pregnancy, defined as a viable intrauterine pregnancy of at least 12 weeks duration confirmed by an ultrasound scan, conceived naturally within 6 months after randomization. Secondary outcomes were time to pregnancy, live birth, sexual health, and personal and relational well-being at baseline and after 3 and 6 months. The primary analyses were according to intention-to-treat principles. We calculated relative risks (RRs, pregnancy rates) and a risk difference (RD, pregnancy rates), Kaplan-Meier survival curves (live birth over time), and time, group, and interactive effects with mixed models analyses (sexual health and well-being).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results and the role of chance: &lt;/strong&gt;Totals of 352 (one withdrawal) and 348 (three withdrawals) couples were allocated to, respectively the P&P group and the expectant management group. Web-based tracking of the intervention group showed a high attrition rate (57% of couples) and limited engagement (i.e. median of 16 visits and 33 min total visitation time per couple). Intention-to-treat analyses showed that 19.4% (n = 68/351) of the P&P group and 22.6% (n = 78/345) of the expectant management group achieved a naturally conceived ongoing pregnancy (RR = 0.86; 95% CI = 0.64-1.15, RD = -3.24%; 95% CI -9.28 t","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":"2711-2721"},"PeriodicalIF":6.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
One fresh cleavage-stage single embryo transfer (SET) plus one frozen-thawed blastocyst-stage SET or one fresh cleavage-stage double embryo transfer? A retrospective matched cohort study. 一次新鲜卵裂期单胚胎移植(SET)加一次冷冻解冻囊胚期单胚胎移植还是一次新鲜卵裂期双胚胎移植?一项回顾性配对队列研究。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1093/humrep/deae245
Zheng Wang, Fang Liu, Kailun Hu, Tian Tian, Rui Yang, Yuanyuan Wang, Rong Li, Ben W Mol, Jie Qiao
<p><strong>Study question: </strong>Are there significant differences in fertility outcomes between transferring two cleavage-stage embryos in a single fresh cycle and transferring one cleavage-stage embryo in a fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle?</p><p><strong>Summary answer: </strong>In women aged <38 years with two embryos available, transferring one cleavage-stage embryo in a fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle increased live birth rates and decreased multiple live birth rates compared to transferring two cleavage-stage embryos in a single fresh cycle.</p><p><strong>What is known already: </strong>The strategy of repeated single embryo transfer (SET) has emerged as a solution to address the reduced live birth rates associated with SET per cycle. There is substantial evidence indicating that the cumulative live birth rate after repeated SET is comparable to that of double embryo transfer (DET), while significantly reducing the incidence of multiple pregnancies. Evidence regarding the outcomes of transferring two cleavage-stage embryos in a single fresh cycle versus transferring one cleavage-stage embryo in one fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle is scarce.</p><p><strong>Study design, size, duration: </strong>This study is a retrospective matched cohort study, where data were gathered from the clinical database of women who underwent IVF treatment at the Reproductive Center of Peking University Third Hospital between January 2011 and December 2019, with follow-up extending until December 2021.</p><p><strong>Participants/materials, setting, methods: </strong>The study group included cycles with a fresh cleavage-stage SET and a subsequent frozen-thawed blastocyst-stage SET (2xSET, N = 976). Fresh cleavage-stage DET was the control group (DET, N = 976). Included cycles were divided into subgroups based on age (≥38 years vs <38 years) and total number of utilizable (transferred or cryopreserved) embryos (=2 vs >2).</p><p><strong>Main results and the role of chance: </strong>The duration of infertility, prevalence of unexplained infertility, and controlled ovarian stimulation regimes differed significantly between the two groups and were adjusted for in the further analysis. We observed a significant increase in clinical pregnancies (55.5% vs 42%, adjusted odds ratio (OR) 1.87 [1.55-2.26]) and live births (44.8% vs 34.5%, adjusted OR 1.63 [1.35-1.97]) in favor of the 2xSET group. The preterm birth rate was lower in the study group (adjusted OR 0.64 [0.42-0.96]). Neonatal birth weight of singletons was similar between the two groups (adjusted B 4.94 g [-84.5 to 94.4]). The beneficial effect on the live birth rate disappeared in cases where aged 38 years and older or when only two embryos were utilizable.</p><p><strong>Limitations, reasons for caution: </strong>This study is limited by differences in baseline chara
研究问题:在一个新鲜周期中移植两个卵裂期胚胎与在一个新鲜周期中移植一个卵裂期胚胎并在随后的冷冻-解冻周期中移植一个囊胚期胚胎在生育结果上是否存在明显差异?在已知年龄的妇女中:重复单胚胎移植 (SET) 策略的出现是为了解决每个周期 SET 导致的活产率降低问题。大量证据表明,重复单胚胎移植后的累积活产率与双胚胎移植(DET)相当,同时显著降低了多胎妊娠的发生率。关于在一个新鲜周期中移植两个卵裂期胚胎与在一个新鲜周期中移植一个卵裂期胚胎并在随后的冷冻-解冻周期中移植一个囊胚期胚胎的结果的证据很少:本研究是一项回顾性配对队列研究,数据来自2011年1月至2019年12月期间在北京大学第三医院生殖中心接受试管婴儿治疗的妇女的临床数据库,随访至2021年12月:研究组包括新鲜卵裂期SET和随后冻融囊胚期SET的周期(2xSET,N = 976)。对照组为新鲜分裂期 DET(DET,N = 976)。根据年龄(≥38 岁 vs 2)将纳入的周期分为不同的亚组:两组患者的不孕持续时间、不明原因不孕的发生率和控制性卵巢刺激方案均有显著差异,并在进一步分析中进行了调整。我们观察到,2xSET 组的临床妊娠率(55.5% 对 42%,调整后的几率比(OR)为 1.87 [1.55-2.26] )和活产率(44.8% 对 34.5%,调整后的几率比(OR)为 1.63 [1.35-1.97])明显增加。研究组的早产率较低(调整 OR 为 0.64 [0.42-0.96])。两组单胎新生儿出生体重相似(调整后 B 为 4.94 克 [-84.5 至 94.4])。在年龄为 38 岁及以上或只有两个胚胎可利用的情况下,对活产率的有利影响消失了:本研究受到两组基线特征差异的限制。对处于分裂期的两个连续 SET 进行分析并不可行。此外,同质化的人群限制了对其他种族群体的推广,在广泛解释结果时应考虑到这一点:我们建议 38 岁以下且有两个以上可用胚胎的女性采用联合策略:在新鲜周期中移植一个卵裂期胚胎,然后在随后的冷冻解冻周期中移植一个囊胚期胚胎。这种策略既能降低囊胚培养失败的风险,又能保持较高的成功率。它为寻求更多孩子的家庭带来了希望,并避免了不必要的胚胎处理:B.W.M.获得了 NHMRC、Ferring、Merck 和 Guerbet 的资助,并从 ObsEva 获得了咨询费和股票期权,他还是 ObsEva 的顾问委员会成员,并为 Guerbet 提供咨询服务,但这些均与本手稿无关。所有其他作者均无利益冲突需要声明:不适用。
{"title":"One fresh cleavage-stage single embryo transfer (SET) plus one frozen-thawed blastocyst-stage SET or one fresh cleavage-stage double embryo transfer? A retrospective matched cohort study.","authors":"Zheng Wang, Fang Liu, Kailun Hu, Tian Tian, Rui Yang, Yuanyuan Wang, Rong Li, Ben W Mol, Jie Qiao","doi":"10.1093/humrep/deae245","DOIUrl":"10.1093/humrep/deae245","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study question: &lt;/strong&gt;Are there significant differences in fertility outcomes between transferring two cleavage-stage embryos in a single fresh cycle and transferring one cleavage-stage embryo in a fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary answer: &lt;/strong&gt;In women aged &lt;38 years with two embryos available, transferring one cleavage-stage embryo in a fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle increased live birth rates and decreased multiple live birth rates compared to transferring two cleavage-stage embryos in a single fresh cycle.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known already: &lt;/strong&gt;The strategy of repeated single embryo transfer (SET) has emerged as a solution to address the reduced live birth rates associated with SET per cycle. There is substantial evidence indicating that the cumulative live birth rate after repeated SET is comparable to that of double embryo transfer (DET), while significantly reducing the incidence of multiple pregnancies. Evidence regarding the outcomes of transferring two cleavage-stage embryos in a single fresh cycle versus transferring one cleavage-stage embryo in one fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle is scarce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design, size, duration: &lt;/strong&gt;This study is a retrospective matched cohort study, where data were gathered from the clinical database of women who underwent IVF treatment at the Reproductive Center of Peking University Third Hospital between January 2011 and December 2019, with follow-up extending until December 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants/materials, setting, methods: &lt;/strong&gt;The study group included cycles with a fresh cleavage-stage SET and a subsequent frozen-thawed blastocyst-stage SET (2xSET, N = 976). Fresh cleavage-stage DET was the control group (DET, N = 976). Included cycles were divided into subgroups based on age (≥38 years vs &lt;38 years) and total number of utilizable (transferred or cryopreserved) embryos (=2 vs &gt;2).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results and the role of chance: &lt;/strong&gt;The duration of infertility, prevalence of unexplained infertility, and controlled ovarian stimulation regimes differed significantly between the two groups and were adjusted for in the further analysis. We observed a significant increase in clinical pregnancies (55.5% vs 42%, adjusted odds ratio (OR) 1.87 [1.55-2.26]) and live births (44.8% vs 34.5%, adjusted OR 1.63 [1.35-1.97]) in favor of the 2xSET group. The preterm birth rate was lower in the study group (adjusted OR 0.64 [0.42-0.96]). Neonatal birth weight of singletons was similar between the two groups (adjusted B 4.94 g [-84.5 to 94.4]). The beneficial effect on the live birth rate disappeared in cases where aged 38 years and older or when only two embryos were utilizable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations, reasons for caution: &lt;/strong&gt;This study is limited by differences in baseline chara","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":"2702-2710"},"PeriodicalIF":6.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564372","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
Female-age-dependent changes in the lipid fingerprint of the mammalian oocytes. 哺乳动物卵母细胞脂质指纹的变化与雌性年龄有关。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1093/humrep/deae225
Simona Bisogno, Joanna Depciuch, Hafsa Gulzar, Maria Florencia Heber, Michał Kobiałka, Łukasz Gąsior, Adrianna Bereta, Anna Pieczara, Kinga Fic, Richard Musson, Gabriel Garcia Gamero, Maria Pardo Martinez, Alba Fornés Pérez, Martina Tatíčková, Zuzana Holubcova, Małgorzata Barańska, Grażyna Ewa Ptak
<p><strong>Study question: </strong>Can oocyte functionality be assessed by observing changes in their intracytoplasmic lipid droplets (LDs) profiles?</p><p><strong>Summary answer: </strong>Lipid profile changes can reliably be detected in human oocytes; lipid changes are linked with maternal age and impaired developmental competence in a mouse model.</p><p><strong>What is known already: </strong>In all cellular components, lipid damage is the earliest manifestation of oxidative stress (OS), which leads to a cascade of negative consequences for organelles and DNA. Lipid damage is marked by the accumulation of LDs. We hypothesized that impaired oocyte functionality resulting from aging and associated OS could be assessed by changes in LDs profile, hereafter called lipid fingerprint (LF).</p><p><strong>Study design, size, duration: </strong>To investigate if it is possible to detect differences in oocyte LF, we subjected human GV-stage oocytes to spectroscopic examinations. For this, a total of 48 oocytes derived from 26 young healthy women (under 33 years of age) with no history of infertility, enrolled in an oocyte donation program, were analyzed. Furthermore, 30 GV human oocytes from 12 women were analyzed by transmission electron microscopy (TEM). To evaluate the effect of oocytes' lipid profile changes on embryo development, a total of 52 C57BL/6 wild-type mice and 125 Gnpat+/- mice were also used.</p><p><strong>Participants/materials, setting, methods: </strong>Human oocytes were assessed by label-free cell imaging via coherent anti-Stokes Raman spectroscopy (CARS). Further confirmation of LF changes was conducted using spontaneous Raman followed by Fourier transform infrared (FTIR) spectroscopies and TEM. Additionally, to evaluate whether LF changes are associated with developmental competence, mouse oocytes and blastocysts were evaluated using TEM and the lipid dyes BODIPY and Nile Red. Mouse embryonic exosomes were evaluated using flow cytometry, FTIR and FT-Raman spectroscopies.</p><p><strong>Main results and the role of chance: </strong>Here we demonstrated progressive changes in the LF of oocytes associated with the woman's age consisting of increased LDs size, area, and number. LF variations in oocytes were detectable also within individual donors. This finding makes LF assessment a promising tool to grade oocytes of the same patient, based on their quality. We next demonstrated age-associated changes in oocytes reflected by lipid peroxidation and composition changes; the accumulation of carotenoids; and alterations of structural properties of lipid bilayers. Finally, using a mouse model, we showed that LF changes in oocytes are negatively associated with the secretion of embryonic exosomes prior to implantation. Deficient exosome secretion disrupts communication between the embryo and the uterus and thus may explain recurrent implantation failures in advanced-age patients.</p><p><strong>Limitations, reasons for caution: </strong>Due t
研究问题:能否通过观察卵母细胞胞质内脂滴(LDs)的变化来评估卵母细胞的功能?在人类卵母细胞中可以可靠地检测到脂质轮廓的变化;在小鼠模型中,脂质变化与母体年龄和发育能力受损有关:在所有细胞成分中,脂质损伤是氧化应激(OS)的最早表现形式,氧化应激会对细胞器和DNA产生一系列负面影响。脂质损伤的标志是低密度脂蛋白的积累。我们假设,衰老和相关的OS导致的卵母细胞功能受损可通过LDs图谱(以下称为脂质指纹(LF))的变化来评估:为了研究是否有可能检测到卵母细胞脂质指纹的差异,我们对人类GV期卵母细胞进行了光谱检测。为此,我们分析了总共 48 个卵母细胞,这些卵母细胞来自 26 名无不孕史的年轻健康女性(33 岁以下),她们都参加了卵母细胞捐献计划。此外,还通过透射电子显微镜(TEM)分析了来自 12 名女性的 30 个 GV 人类卵母细胞。为了评估卵母细胞脂质分布变化对胚胎发育的影响,研究人员还使用了52只C57BL/6野生型小鼠和125只Gnpat+/-小鼠。使用自发拉曼光谱、傅立叶变换红外光谱(FTIR)和 TEM 进一步确认低频变化。此外,为了评估 LF 变化是否与发育能力有关,还使用 TEM 和脂质染料 BODIPY 和尼罗河红对小鼠卵母细胞和囊胚进行了评估。使用流式细胞术、傅立叶变换红外光谱和傅立叶变换拉曼光谱对小鼠胚胎外泌体进行了评估:在这里,我们证明了卵母细胞低频的渐进变化与女性的年龄有关,包括低频区大小、面积和数量的增加。在个体捐献者中也能检测到卵母细胞低密度的变化。这一发现使 LF 评估成为根据同一患者的卵母细胞质量对其进行分级的有效工具。接下来,我们通过脂质过氧化和成分变化、类胡萝卜素的积累以及脂质双层结构特性的改变,证明了卵母细胞与年龄相关的变化。最后,我们利用小鼠模型表明,卵母细胞中的 LF 变化与胚胎植入前的外泌体分泌呈负相关。外泌体分泌不足会破坏胚胎与子宫之间的交流,因此可能是高龄患者反复种植失败的原因:由于不同物种卵母细胞中脂质含量的差异,脂质氧化对哺乳动物卵母细胞发育的影响以及随之而来的LF变化可能有所不同:我们的发现为开发一种创新的卵母细胞评估工具提供了可能,并突出了卵母细胞低密度与胚胎外泌体分泌之间可能存在的功能性联系。通过认识卵母细胞低密度在塑造胚胎植入能力方面的作用,我们的原创性工作为发育生物学和生殖医学的未来研究方向指明了方向:本研究由波兰国家科学中心资助,资助金:2021/41/B/NZ3/03507和2019/35/B/NZ4/03547(给G.E.P.);2022/44/C/NZ4/00076(给M.F.H.)和2019/35/NZ3/03213(给Ł.G.)。M.F.H.是国家学术交流机构(NAWA)研究员(GA ULM/2019/1/00097/U/00001)。K.F.是钻石基金研究员(教育和科学部GA 0175/DIA/2019/28)。本文的公开发表得到了克拉科夫雅盖隆大学 "卓越倡议--研究型大学 "计划下的优先研究领域BioS的资助。作者声明不存在利益冲突:不适用。
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引用次数: 0
Outcomes of female fertility preservation with cryopreservation of oocytes or embryos in the Netherlands: a population-based study. 荷兰通过卵母细胞或胚胎冷冻保存女性生育能力的结果:一项基于人口的研究。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1093/humrep/deae243
M Elena Ter Welle-Butalid, Josien G Derhaag, Bo E van Bree, Ingeborg J H Vriens, Mariëtte Goddijn, Eva M E Balkenende, Catharina C M Beerendonk, Anna M E Bos, Irene Homminga, Sofie H Benneheij, H C van Os, Jesper M J Smeenk, Marieke O Verhoeven, Casandra C A W van Bavel, Vivianne C G Tjan-Heijnen, Ron J T van Golde
<p><strong>Study question: </strong>What are the reproductive outcomes of patients who cryopreserved oocytes or embryos in the context of fertility preservation in the Netherlands?</p><p><strong>Summary answer: </strong>This study shows that after a 10-year follow-up period, the utilization rate to attempt pregnancy using cryopreserved oocytes or embryos was 25.5% and the cumulative live birth rate after embryo transfer was 34.6% per patient.</p><p><strong>What is known already: </strong>Fertility preservation by freezing oocytes or embryos is an established treatment for women with a risk of premature ovarian failure (caused by a benign or oncological disease) or physiological age-related fertility decline. Little is known about the success of cryopreservation, the utilization rate of oocytes or embryos, or the live birth rates.</p><p><strong>Study design, size, duration: </strong>A retrospective observational study was performed in the Netherlands. Data were collected between 2017 and 2019 from 1112 women who cryopreserved oocytes or embryos more than 2 years ago in the context of fertility preservation in 10 IVF centers in the Netherlands.</p><p><strong>Participants/materials, setting, methods: </strong>A total of 1112 women were included in this study. Medical files and patient databases were used to extract data. Women were categorized based on indication of fertility preservation: oncological, benign, or non-medical. To indicate statistical differences the t-test or Mann-Whitney U test was used. Kaplan-Meier analyses were used for time endpoints, and log-rank analyses were used to assess statistical differences. The study protocol was approved by the medical ethics committee.</p><p><strong>Main results and the role of chance: </strong>Fertility preservation cycles have been performed increasingly over the years in the Netherlands. In the first years, less than 10 cycles per year were performed, increasing to more than 300 cycles per year 10 years later. Initially, embryos were frozen in the context of fertility preservation. In later years, cryopreservation of oocytes became the standard approach. Cryopreservation of oocytes versus embryos resulted in comparable numbers of used embryos (median of 2) for transfer and comparable live birth rates (33.9% and 34.6%, respectively). The 5-year utilization rate was 12.3% and the 10-year utilization rate was 25.5%. The cumulative clinical pregnancy rate was 35.6% and the cumulative live birth rate was 34.6% per patient. Those who had fertility preservation due to benign diseases returned earlier to use their cryopreserved embryos or oocytes.</p><p><strong>Limitations, reasons for caution: </strong>The follow-up period after the fertility preservation procedure varied between patients in this study and not all frozen oocytes or embryos had been used at the end of this study. This might have led to underestimated outcomes reported in this study. Furthermore, intention to treat cannot be fully determin
研究问题:在荷兰,冷冻保存卵母细胞或胚胎的患者的生育结果如何?这项研究表明,经过 10 年的随访,使用冷冻保存的卵母细胞或胚胎尝试怀孕的利用率为 25.5%,胚胎移植后每位患者的累计活产率为 34.6%:通过冷冻卵母细胞或胚胎来保存生育能力是一种成熟的治疗方法,适用于有卵巢早衰风险(由良性疾病或肿瘤引起)或与年龄有关的生理性生育能力下降的妇女。人们对冷冻保存的成功率、卵母细胞或胚胎的利用率或活产率知之甚少:在荷兰进行了一项回顾性观察研究。数据收集于2017年至2019年期间,来自荷兰10家试管婴儿中心的1112名女性,她们在2年多前的生育力保存背景下冷冻了卵母细胞或胚胎:本研究共纳入了 1112 名女性。研究使用医疗档案和患者数据库提取数据。根据保留生育能力的指征对妇女进行分类:肿瘤、良性或非医学指征。统计差异采用 t 检验或 Mann-Whitney U 检验。时间终点采用卡普兰-梅耶分析法,统计差异采用对数秩分析法。研究方案已获医学伦理委员会批准:多年来,荷兰的生育力保存周期越来越多。最初,每年进行的周期不到 10 个,10 年后增加到每年 300 多个。最初,胚胎冷冻是在生育力保存的背景下进行的。后来,冷冻保存卵母细胞成为标准方法。冷冻保存卵母细胞和胚胎的结果是,用于移植的胚胎数量相当(中位数为 2 个),活产率相当(分别为 33.9% 和 34.6%)。5 年使用率为 12.3%,10 年使用率为 25.5%。每位患者的累计临床妊娠率为 35.6%,累计活产率为 34.6%。因良性疾病而进行生育力保存的患者较早返回使用其冷冻保存的胚胎或卵细胞:本研究中,不同患者接受生育力保存术后的随访时间各不相同,而且在本研究结束时,并非所有冷冻卵母细胞或胚胎都已使用。这可能导致本研究中报告的结果被低估。此外,由于本研究中未包括开始生育力保存程序但未成功(因反应低而取消)的妇女,因此无法完全确定治疗意向:本研究提供了各种生育力保存适应症后的生殖结果数据。这些知识可为专业人士和未来的患者提供参考,以改善在保留生育力的情况下有关卵巢刺激的咨询和知情决策:本研究未获得任何资助。作者不存在与本研究相关的利益冲突。V.T.H. 从阿斯利康(AstraZeneca)、吉利德(Gilead)、诺华(Novartis)、礼来(Eli Lily)、辉瑞(Pfizer)和第一三共(Daiichi Sankyo)那里获得了资助,用于本研究之外的研究。V.T.H.从 Eli Lily 公司获得了本次研究之外的咨询费。M.G.从加柏公司(Guerbet)和菲林公司(Ferring)获得了本研究之外的研究补助金。E.M.E.B.接受了荷兰生育力保护网络(The Dutch Network of Fertility Preservation)的资助,用于本研究之外的一项研究:不详。
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引用次数: 0
Paternal age, de novo mutations, and offspring health? New directions for an ageing problem. 父亲年龄、新基因突变与后代健康?老龄化问题的新方向
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1093/humrep/deae230
Robert John Aitken

This Directions article examines the mechanisms by which a father's age impacts the health and wellbeing of his children. Such impacts are significant and include adverse birth outcomes, dominant genetic conditions, neuropsychiatric disorders, and a variety of congenital developmental defects. As well as age, a wide variety of environmental and lifestyle factors are also known to impact offspring health via changes mediated by the male germ line. This picture of a dynamic germ line responsive to a wide range of intrinsic and extrinsic factors contrasts with the results of trio studies indicating that the incidence of mutations in the male germ line is low and exhibits a linear, monotonic increase with paternal age (∼two new mutations per year). While the traditional explanation for this pattern of mutation has been the metronomic plod of replication errors, an alternative model pivots around the 'faulty male' hypothesis. According to this concept, the genetic integrity of the male germ line can be dynamically impacted by age and a variety of other factors, and it is the aberrant repair of such damage that drives mutagenesis. Fortunately, DNA proofreading during spermatogenesis is extremely effective and these mutant cells are either repaired or deleted by apoptosis/ferroptosis. There appear to be only two mechanisms by which mutant germ cells can escape this apoptotic fate: (i) if the germ cells acquire a mutation that by enhancing proliferation or suppressing apoptosis, permits their clonal expansion (selfish selection hypothesis) or (ii) if a genetically damaged spermatozoon manages to fertilize an oocyte, which then fixes the damage as a mutation (or epimutation) as a result of defective DNA repair (oocyte collusion hypothesis). Exploration of these proposed mechanisms should not only help us better understand the aetiology of paternal age effects but also inform potential avenues of remediation.

这篇方向性文章探讨了父亲的年龄对其子女的健康和幸福产生影响的机制。这些影响是巨大的,包括不利的出生结果、显性遗传病、神经精神障碍和各种先天性发育缺陷。除年龄外,各种环境和生活方式因素也会通过男性生殖系介导的变化影响后代的健康。男性生殖系对各种内在和外在因素的反应是动态的,这与三组研究结果形成了鲜明对比,三组研究结果表明,男性生殖系的突变发生率很低,并且随着父亲年龄的增长而呈线性、单调增长(每年发生两次新的突变)。对这种突变模式的传统解释是复制错误的节拍性蹒跚,而另一种模式则围绕着 "有问题的雄性 "假说。根据这一概念,男性生殖系的遗传完整性会受到年龄和其他各种因素的动态影响,而正是这种损伤的异常修复导致了突变。幸运的是,精子发生过程中的DNA校对非常有效,这些突变细胞要么得到修复,要么被细胞凋亡/铁蛋白沉积所删除。突变的生殖细胞似乎只有两种机制可以逃脱凋亡的命运:(i)如果生殖细胞获得了一种突变,这种突变通过增强增殖或抑制凋亡而允许其克隆扩增(自私选择假说),或(ii)如果基因受损的精子设法使卵母细胞受精,然后卵母细胞由于缺陷的DNA修复而将损伤固定为突变(或表突变)(卵母细胞串通假说)。对这些假说机制的探索不仅有助于我们更好地理解父系年龄效应的病因,还能为潜在的补救途径提供信息。
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引用次数: 0
24-hour movement behaviours and cardiometabolic markers in women with polycystic ovary syndrome (PCOS): a compositional data analysis. 多囊卵巢综合征(PCOS)妇女的 24 小时运动行为和心脏代谢指标:组成数据分析。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1093/humrep/deae232
E Pesonen, V Farrahi, C J Brakenridge, M M Ollila, L C Morin-Papunen, M Nurkkala, T Jämsä, R Korpelainen, L J Moran, T T Piltonen, M Niemelä
<p><strong>Study question: </strong>Are 24-h movement composition and time reallocations between the movement behaviours (moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behaviour (SB), and sleep) differentially associated with cardiometabolic markers in women with polycystic ovary syndrome (PCOS) relative to women without PCOS?</p><p><strong>Summary answer: </strong>There was no difference in 24-h movement composition between the groups, although among women without PCOS, reducing SB time while increasing either MVPA or LPA time was associated with beneficial differences in cardiometabolic markers, whereas in women with PCOS beneficial differences were observed only when SB time was replaced with MVPA.</p><p><strong>What is known already: </strong>Women with PCOS display lower levels of physical activity, higher sedentary time, and less total sleep than women without the syndrome. Exercise interventions among women with PCOS have shown improvements in body composition and insulin sensitivity, while the findings regarding blood pressure, insulin resistance, and lipid profiles are contradictory.</p><p><strong>Study design, size, duration: </strong>This study was part of a prospective, general population-based Northern Finland Birth Cohort 1966 (NFBC1966) (n = 5889 women). At the 31-year and 46-year follow-up, data collection was performed through postal and clinical examinations, including fasting blood samples and anthropometric measurements. Accelerometer data collection of 14 days (n = 2602 women) and a 2-h oral glucose tolerance test (n = 2780 women) were performed at the 46-year follow-up. Participants were identified as women with or without PCOS at age 31 (n = 1883), and the final study population included those who provided valid accelerometer data at age 46 (n = 857).</p><p><strong>Participants/materials, setting, methods: </strong>Women with PCOS (n = 192) were identified based on the 2023 International Evidence-based Guideline, while those who exhibited no PCOS features were considered women without PCOS (controls; n = 665). Accelerometer-measured MVPA, LPA, and SB were combined with self-reported sleep to obtain 24-h compositions. Multivariable regression analysis based on compositional data analysis and isotemporal reallocations were performed to investigate the associations between 24-h movement composition and cardiometabolic markers. Isotemporal reallocations were expressed as differences (%Δ) from the sample's mean.</p><p><strong>Main results and the role of chance: </strong>There was no difference in overall 24-h movement composition between women with PCOS and controls in midlife. The 24-h movement composition was associated with waist circumference, triglycerides, fasting serum insulin, and Homeostatic Model Assessment-insulin resistance (HOMA-IR) in both controls and women with PCOS. Reallocating 15 min from SB to MVPA was associated with favourable differences in cardiometabolic markers
申报了 Gedeon Richter、Organon、Astellas、Roche 的咨询费;Gedeon Richter、Exeltis、Roche、Stragen、Merck、Organon 的演讲费;以及 Gedeon Richter 的差旅资助。其余作者声明无利益冲突:不适用。
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引用次数: 0
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Human reproduction
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