Human Fertility最新文献

The cystic fibrosis transmembrane conductance regulator (CFTR) is a cAMP-activated trans-membrane ATP gated anion channel present in most epithelia, which transports chloride and bicarbonate ions across the apical membrane. Mutations in the CFTR protein are known to result in defective expression or function, notably the inhibition of chloride and bicarbonate transport. This can result in cystic fibrosis (CF), a disorder characterised by thickness of the mucus lining of the epithelial cells of the alimentary and respiratory tracts, sweat ducts and reproductive organs. As a consequence, there is a reduction in fluid transport at the apical surface. While the most devastating effect of CF is mortality, about 98% of men with CF are infertile, consequent of early blockage of or failure to develop the mesonephrotic ducts as well as the vas deferens. The effect of CF of female fertility is less well-understood. This review highlights the genetics and pathophysiology as well as the mechanism of action of CF on female infertility.

Couples trying to conceive or providing samples for Assisted Reproductive Technologies (ART) are advised against the use of lubricant-gels due to the risk of sperm-toxicity. However, gels now exist which are specifically formulated to help couples conceive but without consensus on their toxicity relative to non-specialist products. This study tested gels recently introduced as 'sperm friendly' (FertilSafe Plus, Fertile Check) alongside established lubricants intended for pleasure only using a recently published toxicity testing regime. Computer Assisted Sperm Analysis (CASA) was performed at 1 and 2 h on donor sperm (n = 12) pre-incubated with each gel (10% v/v) and controls. All gels led to a significant loss of motility/velocity at 1 and 2 h (p < 0.01), with the most significant loss from the 2 Durex pleasure products (11% and 15%, vs 47% progression) at 60 min, although these performed better than saliva (used as negative control). Incubation with FertilSafePlus led to the smallest loss of motility (24% vs 47%) at 1 h. Saliva and products designed for lubrication only exhibited the most negative effect on motility and those marketed as 'sperm safe' could be considered the best performers. Whether these affects are due to direct toxicity or are indirect due to other factors such as viscosity, pH or osmolality remains uncertain.

We aimed to determine if a programme change to 12 hourly injections of FSH (150 IU per injection) for the first 2 days of stimulation in women with high ovarian reserve (AMH ≥ 30 pmol/L), followed by 24 hourly injections, would elicit increased earlier follicular recruitment, higher egg yields and blastocyst embryos for cryopreservation, leading to potential higher cumulative pregnancy rates, than conventional daily injections throughout. For safety reasons, the approach required mandatory cryopreservation of all blastocysts (mFET group; n = 74), after ovulation trigger with GnRH-agonist, in GnRH-antagonist controlled cycles. The 'Comparator group' (n = 91) comprised women with the same high AMH levels treated with the same base dose of FSH, with the aim of fresh blastocyst transfer and cryopreservation of supernumerary embryos, treated over the preceding 2 years. There was no difference in age, AMH, weight or BMI between the groups. The mFET group achieved higher egg (17.7 versus 11.7; p < 0.001) and embryo (10.9 versus 7.2; p < 0.001) yields and fewer cases with sub-optimal embryo yields (7% versus 22%; p = 0.018). The cumulative live birth rate was superior in the mFET group (73% versus 43%), as was the safety profile, and negligible rate of treatment plan modification.

Egg donation in New Zealand is identity-release, with donor-conceived individuals having the right to access donors' identifying information at the age of 18. It also allows donors and previously unknown recipients to meet prior to donation. Further, donation is altruistic, although reimbursement of costs is possible. In our previous paper we explored the motivations of 21 egg donors in this context and reported that they are motivated to donate as an act of personal gift-giving to recipients who may become known to them through donation, and that they do not want to be compensated for this financially. In this paper, drawing on in-depth interviews, we report on donors' experiences of the donation process and subsequent to donation. Donors understood their donations to be a significant act, both for the recipients and their families, but also for themselves, particularly given the multiple sacrifices which they willingly made. Donors wished for their gift and their role to be valued and acknowledged through being appreciated, informed, involved and supported by recipients and clinics before, during and after their donations. These findings have implications for clinical practice and care, offering insight into how best to support donors prior and subsequent to donation.

Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.

Infertility is regarded as a highly stressful and challenging experience. However, the response to this unexpected moment varies from one individual to the other. The review explores research that studies resilience in the context of infertility and its treatment. The purpose was to study the protective and risk factors associated with resilience and to identify psychosocial factors that could play a crucial role in resilience among infertile couples and individuals who are seeking infertility treatment. Four major databases (PubMed, Scopus, ScienceDirect, and Wiley Online Library) were searched with appropriate keywords. A total of 4101 articles were retrieved from the databases and after following various levels of screening 18 articles were finalized. These articles explored resilience and other psychosocial factors in couples/individuals seeking infertility treatment. The protective factors associated with resilience were quality of life, coping, social support, and posttraumatic growth. The risk factors associated with resilience were infertility-related stress, anxiety and depression. The unexpected diagnosis of infertility might be disturbing for many, still, it may not be extremely agonizing for some. Individuals who are encouraged to utilize their own resources and seek support are able to deal with stressors associated with infertility.

Ovarian response to stimulation mainly determines the length of stimulation. However, there is no clarity in the literature regarding the optimal duration required to achieve oocyte maturity in patients with the poor ovarian response (POR) defined by Bologna criteria. Therefore, a total of 267 cycles that fulfilled the inclusion criteria were selected retrospectively. Group A constitute of patients with a stimulation period < 9 d (n = 70); and group B included patients with a stimulation period ≥ 9 d (n = 133). The results showed that antral follicle count (5.72 ± 1.82 vs. 5.10 ± 1.78, p = 0.023), serum oestradiol level on hCG day (1286.88 ± 778.18 pg/mL vs. 820.14 ± 479.04 pg/mL, p = 0.001), and total gonadotropin dose used (2949.53 ± 727.92 IU vs 2020.94 ± 415.17 IU, p = 0.0001) were higher in group B when compared to group A. Although the number of total (5.47 ± 3.32 vs 3.86 ± 2.15, p = 0.0001) and mature oocytes retrieved (4.34 ± 2.88 vs 2.84 ± 1.67, p = 0.0001) were higher in group B, no significant difference was observed in the pregnancy rates between groups (25.6 vs 15.7%, p > 0.05). In conclusion, no deleterious effect of a shorter duration of stimulation on cycle outcome was seen in patients with POR.

This retrospective cohort study aimed to compare clinical outcomes following fresh or frozen embryo transfer (FET) in women with advanced reproductive age (ARA). Women aged 35-45 years who underwent their first autologous fresh or frozen cleavage stage embryo transfer cycle in the Centre for Assisted Reproduction of Shanghai First Maternity and Infant Hospital between January 2016 and December 2020 were included. The primary outcome was live birth after the first embryo transfer of the in vitro fertilization (IVF) cycle. Multiple covariates were used for propensity score matching (PSM) and generalized estimating equations were performed to examine the independent association between FET and live birth. Of the total 1453 patients, 327 patients had FET and 1126 patients had fresh ET. After the PSM procedure, 274 patients were included in each group. The live birth rate was 24.8% in the FET group and 25.2% in the fresh ET group (OR 0.98, 95% CI: 0.67-1.44, P = 0.92). Other pregnancy, perinatal and neonatal outcomes were all comparable between the two groups. This study showed that FET did not improve live birth and other clinical outcomes as compared with fresh embryo transfer in women with ARA who underwent their first IVF cycle.

A significant problem associated with assisted reproductive technologies (ART) is recurrent treatment failure which can be attributed to the age-associated decline in oocyte quality. Co-enzyme Q10 (CoQ10) is an antioxidant and essential component of the mitochondrial electron transport chain. It is reported that de novo CoQ10 production declines with ageing and coincides with age-related decline in fertility, leading to CoQ10 supplementation being advocated to enhance response to ovarian stimulation and improve oocyte quality. CoQ10 supplementation was found to improve fertilization rates, embryo maturation rates and embryo quality when used before and during in vitro fertilization (IVF) and in vitro maturation (IVM) treatment in women aged 31 and over. Regarding oocyte quality, CoQ10 was able to reduce high rates of chromosomal abnormalities and oocyte fragmentation, as well as improve mitochondrial function. Proposed mechanisms of CoQ10 function include restoration of reactive oxygen species imbalance, preventing DNA damage and oocyte apoptosis, as well as restoration of Krebs cycle downregulation from ageing. In this literature review, we provide an overview of the use of CoQ10 in improving the success of IVF and IVM in older women, and additionally assess the impact of CoQ10 on oocyte quality and discuss potential mechanisms of action by CoQ10 on the oocyte.

With the growing challenge of abandoned surplus embryos in the ART arena, and the limited traction of embryo donation as a viable embryo disposition choice, it is important to better understand barriers to wider adoption of this opportunity. We aim to learn about perspectives and experience of participants in directed and non-identified embryo donation programmes. This was a longitudinal cohort survey study, of all participants in an embryo donation programme in a single university affiliated clinic between 2016 and 2020. Clinical data were extracted from counselling reports. Based on these data, non-identified online questionnaires were constructed and refined via Delphi procedure for face and content validity. Sixty-five online questionnaires were emailed between March-April 2021. Descriptive statistics, cross-tabulation, Fisher's exact test and t-test were used for analyses. Source of patient awareness, factors influencing the decision-making process, patient perspective and satisfaction were explored. The response rate was 67.2%. Most participants in the non-identified programme learned of it through their treating physicians, whereas most participants in the directed programme learned of it online. The main driver to donate across both cohorts was wanting to give others the opportunity to experience the joy of parenthood. Overall, 45% described moderate to marked difficulty in decision making related to donating their embryos, and this did not differ between cohorts. Non-identified donors reported feeling highly attached to the donated embryos more often than directed donors. Level of satisfaction was higher in the directed donation programme. Participants were more satisfied following directed than non-identified donation, and some even consider their counterparts as extended family. Our findings should be validated in various settings, and on larger samples.