Human Fertility最新文献

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.

Frozen embryo transfer (FET) has been associated with higher risks of hypertensive disorders of pregnancy (HDP), large for gestational age and high birth weight. This systematic review and meta-analysis evaluates obstetric and perinatal outcomes in medicated, stimulated and natural FET cycles. A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Library database; 152,590 FET cycles were analysed from 31 included studies. Risk ratios (RR) and 95% confidence intervals (CI) were calculated using fixed and random effects models determined by the heterogeneity (I²). There was significantly higher risk of obstetric and perinatal complications, including HDP (RR 1.84, CI:1.48-2.29, I² 87%) and low birth weight (LBW) (RR 1.25, CI:1.12-1.39, I² 57%) following medicated compared to natural FET cycles. A higher risk of HDP (RR 1.50, CI:1.33-1.64, I² 32%) and macrosomia (RR 1.28, CI:1.17-1.40, I² 37%) was noted following medicated compared to stimulated cycles. Natural demonstrated lower risk of HDP (RR 0.77, CI:0.60-0.99, I² 32%), gestational diabetes (RR 0.78, CI:0.68-0.89, I² 43%), LBW (RR 0.78, CI:0.64-0.95, I² 48%) and small for gestational age (RR 0.83, CI:0.70-0.98, I² 12%) than stimulated cycles. These findings indicate that medicated FET cycles convey greater risks of obstetric and perinatal complications than natural or stimulated cycles.

To systematically evaluate the quality, credibility, accuracy, and readability of fertility-related content generated by users providing education, advice, and medical information on Twitter/X and Instagram. We selected Instagram and Twitter/X for data collection, as these platforms are commonly used by women of reproductive age. Using the terms 'fertility' and 'infertility', we collected posts both prospectively and retrospectively between April 21 and 28, 2024, using Keyhole and Brand Mentions. Posts were screened for eligibility, excluding non-English language posts, personal stories, advertisements, non-medical opinions, and peer-support posts. We assessed the accuracy, credibility, quality, and readability of the posts using validated instruments. Accuracy was evaluated based on current guidelines and the authors' expertise in infertility. Credibility was measured using a 10-point system that considered the source, context, currency, and editorial review. Quality was assessed using the 16-item DISCERN criteria with a five-point Likert scale. Readability was measured using the Flesch-Kincaid reading-ease test, which assigns a U.S. grade level to each post. Of the 15,214 posts identified, 939 were included in the final analysis. Fertility doctors generated 29% of the posts; others came from doctors of other specialties (11%), holistic practitioners (17%), and laypeople (39%). Seventy-four percent (74%) of posts did not cite sources or academic references, and 45% of posts contained inaccurate information. Only 11% of the posts were deemed credible. Of posts related to treatment, 19% were of high quality, while 53% of non-treatment posts met the same standard. Most posts (80%) were categorized as difficult to read based on readability scores. Only two posts (0.2%) were accurate, credible, high-quality, and easily readable. Social media posts about fertility often provide incomplete or misleading information, with a significant focus on naturopathy, dietary advice, and unproven theories about the effect of the COVID-19 vaccine on fertility. Clinicians and social media platforms must take responsibility for improving the accuracy and accessibility of health information online.

Infertility significantly impacts people worldwide, with many pursuing medical treatments including Assisted Reproductive Technologies (ART). This scoping review explores the role of allied health professionals (AHPs) in fertility care and their integration into fertility care teams. A search of six databases yielded 12 studies identifying dietitians, nutritionists, counsellors, psychologists, social workers, and physical therapists (physiotherapists) as key AHPs in fertility care. The role of AHPs was broadly divided into two main areas: providing education and monitoring related to lifestyle modifications and fertility risk factors and offering psychological and psychosocial treatment and support. Dietitians educate patients on nutrition and lifestyle modifications to improve fertility. Mental health professionals, including psychologists, social workers, and counsellors, address the emotional stress of infertility and help patients cope with ART. Physical therapists perform therapies to increase chances of conception. The integration of AHPs into fertility care teams vary by location and facility practices with some working within healthcare teams and others independently. Despite guidelines, the incorporation of AHPs into fertility care is inconsistent, highlighting the need for a standardized approach. This review highlights AHP roles in providing education, lifestyle modification guidance, and psychosocial support which are valuable in enhancing patient care and potentially improving ART outcomes.

Research suggests that donor conceived persons (DCP) may not only be interested in their genetic information, but in meeting donors and other genetically related individuals. While parental disclosure to donor conceived children (DCC) appears to be increasing, limited research examines the impact of disclosure and donor linking for DCP and parents. This research explores the experiences of nine heterosexual parents in New Zealand who mostly conceived prior to identity-release provisions and whose DCC have searched for or had donor contact. Data was collected via semi-structured interviews and analysed using thematic analysis. Findings suggest that parents valued their children's access to genetic origins and viewed donor linking as a natural outcome of disclosure. Parents positioned themselves as facilitators or supporters of linking, while emphasising that linking should be DCP led. Donor and donor family willingness were noted as key in enabling contact. Early disclosure and support for linking were held to strengthen parent-child relationships, while later disclosure and difficulty in linking were associated with relationship tension. Relationships with donors ranged from distant to familial, with most parents noting that DCC valued connections with siblings. Parents reflected on the significant impacts of family-building through donor conception and the need for ongoing support.

This retrospective cohort study evaluated 1,193 women undergoing first fresh IVF cycles to assess the effects of insulin resistance (IR) and overweight/obesity on outcomes. Participants were stratified by BMI and IR status. Overweight/obese women without IR exhibited comparable IVF outcomes to normal-weight controls. Untreated IR, however, significantly impaired outcomes, including fewer oocytes retrieved, 2PN zygotes, available embryos, and good-quality embryos all p ≤ 0.002), alongside lower fresh cycle live birth rates (34.4% vs. 53.3%, p = 0.038), implantation rates (32.1% vs. 47.8%, p = 0.023), cumulative pregnancy rates (45.8% vs. 68.4%, p = 0.001), and cumulative live birth rates (41.7% vs. 58.4%, p = 0.006). Notably, IR correction improved 2PN zygote formation (p = 0.026), numbers of available embryos (p = 0.021), fresh cycle live birth rates (57.6% vs. 34.4%, p = 0.034), cumulative pregnancy rates (63.2% vs. 45.8%, p = 0.018), and cumulative live birth rates (56.8% vs. 41.7%, p = 0.041). Multivariate analysis confirmed homeostasis model assessment of insulin resistance (HOMA-IR) as an independent negative predictor of live birth (OR = 0.49, 95% CI 0.30-0.82, p = 0.006). The findings challenge BMI-centric risk stratification in ART, emphasizing IR's role in compromising embryo quality and clinical outcomes. Preemptive IR screening and treatment in overweight/obese women are crucial.

The consequences of age-related fertility decline could be prevented by an increased uptake in ovarian reserve testing and social egg freezing (SEF) at an appropriate age. This study aimed to investigate the knowledge and views of UK-based women towards age-related fertility decline, egg reserve testing and SEF. UK-based women (n = 973) aged 18-50 years were voluntarily recruited from social media groups by convenience sampling between September 2021 and April 2022. Participants completed a previously validated questionnaire regarding their knowledge and opinions of egg reserve testing and SEF. Only 19.5% of participants were aware of the low success rates of IVF at an advanced age. 40.9% and 94.4% of respondents were aware of ovarian reserve testing and SEF, respectively. 86.8% and 86.5% of respondents were open to the idea of having their ovarian reserve checked or to undergo SEF, respectively. When faced with a hypothetical low ovarian reserve, most respondents would seek fertility advice. The benefits of SEF ranked consistently higher than the potential issues. Women who participated in this study were open to taking advantage of ovarian reserve testing and SEF. Our findings also reveal the need for increased education of fertility topics to both the general public and healthcare professionals.

Patient consent is a fundamental legal and professional requirement of any intervention offered to a patient and must include discussion of risks and benefits. The number of women becoming pregnant via oocyte donation has increased markedly in recent years. Such pregnancies are accompanied by different risks to those of naturally conceived pregnancies. Anecdotal evidence suggests that women seeking oocyte donation pregnancy gain limited appreciation of the risks attending oocyte donation during consent discussions. To explore women's understanding of the risks associated with oocyte donation pregnancy a qualitative interview study was conducted in an ante-natal facility in an urban hospital. Sixteen women who had experienced oocyte donation pregnancy participated in semi-structured, audio-recorded interviews exploring their experience of the consent process for oocyte donation and their awareness of pregnancy-related risks once pregnant. Data were analysed using thematic analysis. Our principal finding was that women were unaware that their oocyte donation pregnancy carried higher risks than a typical IVF pregnancy. Three themes emerged: (1) women tended to care most about risks associated with success/failure of oocyte donation; (2) women did not know that oocyte donation pregnancies carry specific risks above and beyond IVF pregnancies; (3) women were ambivalent towards receiving risk information. For women accepting an oocyte donation consent at the time of undergoing IVF should include discussion of the risks of subsequent pregnancy to ensure that women are fully informed. Women's understanding of risks should be routinely checked ante-natally.

Bladder hematoma following transvaginal ultrasound-guided oocyte retrieval (TVOR) is rare. We conducted a retrospective analysis of 33,271 patients who underwent TVOR procedures during in vitro fertilization and embryo transfer (IVF-ET) at our centre between January 2015 and June 2023. Additionally, a systematic literature search on bladder haematoma after TVOR was performed. Data on clinical symptoms, diagnostic processes, and treatment interventions for patients with bladder injurie or haematoma were collected and analyzed. We identified six cases (0.018%) of bladder injury following TVOR procedures at our centre. Nine studies reporting 12 cases of bladder haematoma, yielding a pooled incidence of approximately 0.02%. Bladder haematoma occurred at various times after the procedure, ranging from immediate to a maximum of seven days post TVOR. Of the 18 cases examined, four patients received conventional conservative treatment, while 12 patients underwent urinary catheter irrigation and drainage. The most common clinical symptoms included lower abdominal pain, urinary frequency, dysuria, visible haematuria, and urinary retention. Bladder haematoma resulting from bladder injury after TVOR is a rare complication. To reduce the risks associated with such complications, it is crucial to develop protocols that ensure appropriate prophylaxis, monitoring, and treatment for patients undergoing TVOR procedures.