Human Fertility最新文献

Knowledge of ovulatory cycle (KOC) is a crucial factor for successful conception. Despite sizable number of women suffering from infertility, empirical evidence on the relation between infertility and KOC is rare in South Asia. This study assesses the association between primary infertility and KOC. The data of ever-married women aged 20-49 gathered in the recent rounds of Demographic and Health Survey (DHS) for India (2019-2021), Bangladesh (2017-2018), Pakistan (2017-2018) and Nepal (2022) were analyzed. Bivariate analysis and binary logistic regression were conducted through Stata (V.17) with a 5% significance level. Women with no KOC in India [AOR:1.71, C.I.: (1.54, 1.9)] and Bangladesh [AOR:2.6, C.I.: (1.67, 4.06)] had higher odds of primary infertility than their counterparts with correct KOC. The study concludes that correct KOC is a significant predictor of primary infertility in India and Bangladesh and is insignificant in Pakistan and Nepal. Moreover, higher age at marriage and no-visit to healthcare facility were the other significant predictors of primary infertility in all four countries. Women who are struggling to conceive would benefit from education related to the timing and identification of the fertile window, which may be provided through primary healthcare providers.

To understand whether there was an association between very young oocyte donors and adverse outcomes, this was a single centre retrospective study (Lister Fertility Clinic, London) examining data collected between 1st January 2010 and 31st December 2021. A total of 1,182 oocyte donors were included in the final analysis. Data was categorised by donor age in years; ≤22, 23-25, 26-28, 29-31, 32-34. Statistical analysis was performed using SPSS. Donors aged ≤22 years showed increased live birth rates (LBR) in fresh In Vitro Fertilisation (IVF) cycles when compared to donors aged 26-28 (p < 0.0136), 29-31 (p < 0.0044), and 32-34 (p < 0.0003) years, respectively. There was also an increased positive pregnancy rate in fresh IVF cycles for donor oocytes ≤22 years when compared to all other groups. The LBR and positive pregnancy rates decreased with increasing oocyte age with fresh IVF cycles. There was no significant difference in the LBR with frozen IVF cycles compared to fresh IVF cycles. Our data showed that very young oocyte donors are in fact associated with improved IVF outcomes, especially in fresh IVF cycles.

Following reports of mpox infections in Europe and the Americas, the World Health Organisation has declared that mpox constitutes a public health emergency of international concern. Since the mpox virus (MPXV) has been detected in semen of MPX-infected men, this puts healthcare professionals in medically assisted reproduction clinics, such as clinical embryologists and andrologists, at risk of MPX infection by handling semen from infected men. This commentary provides information about MPXV and highlights vigilance steps with regards to processing semen, oocytes, pre-implantation embryos and pregnancies of MPXV infected persons.

Donation of substances of human origin (SoHO) is essential for the treatment of many patients and ranges from the donation of whole organs to the donation of tissue or cell products, including also gamete donation. In order to ensure the safety of recipients of SoHOs there are multiple steps taken in the donation pathway of all such substances to ensure the quality and safety of the donation. However, despite this, there is always a residual risk associated with SoHOs. The recent Infected Blood Inquiry (IBI) report has described in detail the background to the inadvertent transmission of HIV and hepatitis C to many patients in the past and has provided a number of recommendations. While the IBI focused on blood donation and the risk of blood borne virus transmission, the underlying principles are pertinent to all SoHOs, including gamete donation, and to all risks associated with SoHOs not just the risk of blood borne virus transmission.

Sperm DNA contains strand breaks and base damage that can potentially affect reproductive health. This study aims to determine to what extent sperm DNA integrity and alkylation is associated with semen quality and assisted reproduction technology (ART) treatment outcomes, in particular fertilisation and cleavage rates. Male partners of couples attending for infertility treatment were recruited. DNA integrity (% tail DNA, sperm with either low (LDD) or high (HDD) damage levels) was measured by a neutral Comet assay and N7-methyldeoxyguanosine (N7-MedG) DNA levels by an immunoslotblot in sperm prepared by density gradient centrifugation. Associations between DNA damage, semen quality and ART treatment outcomes were assessed. N7-MedG levels were lower and the proportion of LDD sperm higher in prepared than in neat sperm samples. The proportion of HDD sperm and % tail DNA were significantly negatively associated and the proportion of LDD sperm positively associated with semen quality. Fertilisation, but not cleavage, rate nor live birth, was significantly negatively associated with N7-MedG levels, the proportion of HDD sperm and % tail DNA and was positively associated with the proportion of LDD sperm. These results confirm that DNA damage, even in prepared sperm, is associated with adverse semen quality and suggest that sperm DNA damage affects the early stages of embryo formation.

To evaluate whether oocyte cryopreservation affects obstetric and perinatal outcomes, 350 donor oocyte recipients with live-born singletons were divided into three groups: frozen embryo transfer (FET) with fresh oocytes (n = 101), fresh embryo transfer (ET) with frozen oocytes (n = 190), FET with frozen oocytes (n = 59). Gestational age differed significantly (P = 0.025), with the FET with frozen oocytes group showing longer gestational age than FET with fresh oocytes group (276 days vs. 272 days, P = 0.04). Other outcomes were comparable among groups. Subgroup analysis of FET pregnancies revealed no significant differences between frozen and fresh oocyte groups in gestational age (B 1.38, P = 0.749), birth weight (B -0.11, P = 0.530), premature birth rates (6.8% vs. 11.9%, P = 0.746), low birth weight (LBW) (5.1% vs. 12.9%, P = 0.865), macrosomia (5.1% vs. 4.0%, P = 0.976), small for gestational age (SGA) (6.8% vs. 11.9%, P = 0.599), large for gestational age (LGA) (22.0% vs. 18.8%, P = 0.943), gestational diabetes mellitus (GDM) (10.2% vs. 11.9%, P = 0.343), hypertensive disorders of pregnancy (HDP) (8.5% vs. 17.8%, P = 0.143) or placental abnormalities (8.5% vs. 19.8%, P = 0.133). The study confirmed oocyte cryopreservation did not affect birth weight or obstetrical complications in donor oocyte recipients.

This British Fertility Society (BFS) Policy and Practice guideline aims to support clinicians in preventing ovarian hyperstimulation syndrome (OHSS) in patients undergoing gonadotropin ovarian stimulation. A systematic literature search of the medical databases was performed. The Guideline Development Group (GDG) identified the risk factors of OHSS before and during ovarian stimulation. The relation of different pre-treatment measures and different ovarian stimulation protocols with OHSS was evaluated. The optimal monitoring during treatment was assessed. The current evidence on preventive strategies during and after ovarian stimulation and the available adjuvant preventive agents were examined. Based on this, the GDG developed evidence-based, graded recommendations for clinical practice. The evidence was evaluated within context, considering the effectiveness, cost and practical problems of assisted reproductive technology for patients and healthcare providers. Early identification and application of preventive measures identified in this guideline may reduce the incidence of OHSS or reduce its severity. Suggestions for future research on OHSS prevention are provided.

This study aimed to evaluate the effectiveness of changing the insemination method in women who experienced poor embryonic development during the preceding cycle. A total of 15,886 conventional IVF in 9,311 women, performed between August 2015 and June 2023, were included in this study. Of these, 270 couples experienced IVF failure due to poor embryonic development in the first oocyte retrieval (OR) cycle, which was cancelled before transfer. The patients were stratified based on whether or not they switched to ICSI for subsequent attempts. Cumulative live birth rates (CLBRs) and a series of secondary outcomes were compared. The embryo utilization, high-quality embryo, blastocyst formation, implantation, cumulative clinical pregnancy, CLBR and miscarriage rates were comparable between the two groups, whereas the fertilization rate per oocyte retrieved was significantly lower in the ICSI group during the second OR cycle (60.76% vs. 70.42%, p < 0.001) and all OR cycles (60.02% vs. 71.69%, p < 0.001). Furthermore, the CLBRs in the ICSI and IVF groups after up to seven OR cycles were 41.35% and 36.84%, respectively. Most patients achieved live births during the second OR cycle (58.33%, ICSI vs. 62.86%, IVF). ICSI did not improve clinical or embryonic outcomes in women who experienced poor embryonic development in their preceding cycle.

The need for fertility education arises from changing patterns of family formation in recent times. Young people feel unprepared for how best to plan their career and family and have little idea of the various factors that may influence their fertility later in their life. Research shows young people would like to know more and need the information to be conveyed in a way that is engaging and helps them to integrate it at their current life stage. The Fertility Education Initiative (FEI) was founded in 2016 to address the need for improved fertility and reproductive health awareness and ensure young people are equipped with the relevant information to meet their reproductive and family building needs. This paper serves as a historical record of the genesis of the FEI and its impact to date.

The effect of an increase in luteinizing hormone levels on pregnancy outcomes in patients undergoing artificial endometrial preparation for frozen embryo transfer has not been definitively elucidated. We aimed to investigate the effect of elevated luteinizing hormone levels, measured prior to progesterone administration, on the ongoing pregnancy rate in patients undergoing artificial endometrial preparation for single vitrified-warmed blastocyst transfer. Patients began taking oral oestradiol valerate on menstrual day 2-3. When the endometrial thickness reached ≥7 mm, they were tested for oestradiol, progesterone, and luteinizing hormone, and luteal phase support was started. The participants were divided into four groups based on luteinizing hormone percentiles, and differences in pregnancy outcomes were examined. No significant differences were observed for on-going pregnancy rate and the other pregnancy outcomes between the groups. In multivariate logistic regression analysis, not the luteinizing hormone levels but the quality of embryo had a significant influence on ongoing pregnancy (p = 0.004; adjusted odds ratio, 1.8; 95% confidence interval, 1.213-2.675). The elevation of luteinizing hormone levels during artificial endometrial preparation did not have an impact on the ongoing pregnancy or the other pregnancy outcomes.