Human Fertility最新文献

Although the deleterious impact of chemotherapy regimen used to treat women of reproductive age with breast cancer on ovarian reserve has been extensively studied, hardly anything has been reported on the effect of these protocols on theca cell function and ovarian androgen secretion. The aim of this prospective multicentric cohort study was to describe serum levels of total testosterone and androstenedione during chemotherapy and 24-month follow-up in 250 patients <40 years treated for breast cancer. Mean basal levels of androstenedione and total testosterone at diagnosis were 1.68 ng/mL and 0.20 ng/mL respectively. No correlation with age was found. Serum levels of androstenedione and total testosterone rapidly decreased after chemotherapy completion, before slowly increasing and almost returning to basal levels in all patients during 2-year follow-up. In conclusion our study demonstrates a chemotherapy-induced alteration of ovarian thecal function, resulting in a significant decrease in serum androgen levels. This alteration of theca cell function adds to the well-known alteration of granulosa cell function, resulting in a global, but partly transient, ovarian failure in young women treated for breast cancer. These data bring new insight into ovarian physiology and emphasize the need for pre and post-treatment ovarian follow-up. Trial registration: ClinicalTrial.gov identifier NCT01114464.

Reproductive travel for gamete donation is becoming increasingly common. South Africa is renowned for its availability and relative affordability of high-quality assisted reproductive technology (ART) services. In South Africa (SA) gamete donation is anonymous by law and donors are compensated. Due to its significant availability of donors, SA is a popular destination for people who need donor gametes. The aim of this study was to assess the quality and comprehensiveness of information for oocyte donors available on donor agency websites in SA. A Google search was performed to compile a list of oocyte donor agency websites and content analysis was used to assess the comprehensiveness of the information for donors. Information on 12 websites was analysed. Overall, wording suggested that oocyte donation is a safe and easy procedure which is a process worth experiencing. Possible physical risks and psychological implications of donating oocytes were either not mentioned or downplayed. No website mentioned if or how donors would be followed up after oocyte retrieval or how they would be cared for in case of complications. No website informed donors about the possibility of genetic testing revealing their identity to a child born from their donation. The lack of transparency about the psychological implications and potential risks of donating oocytes suggests that women who contemplate donating oocytes in SA may not have the information they need to make informed decisions about whether to proceed. Since donor agency websites are potential donors' primary source of information, they should provide comprehensive information about all aspects of oocyte donation. This should include transparent and comprehensive information about the known physical and psychological risks. Donors also need to know that oocyte donation may have unknown long-term health risks and that direct-to-consumer genetic testing may reveal their identity to children conceived through their donation in the future.

This study aims to systematically analyze the provision of information on Time-lapse Imaging (TLI) by UK fertility clinic websites. We conducted an analysis of 106 clinic websites that offer fertility treatment to self-funded patients. The analysis aimed to examine whether these clinics offer TLI, the associated cost for patients, and the clarity and quality of the provided information. Out of the 106 websites analysed, 71 (67%) claimed to offer TLI. Among these websites, 25 (35.2%) mentioned charging patients between £300 and £850, 25 (35.8%) claimed not to charge patients, and 21 (29.6%) did not provide any cost information for TLI. Furthermore, 64 (90.1%) websites made claims or implied that TLI leads to improved clinical outcomes by enhancing embryo selection. Notably, 34 (47.9%) websites did not mention or provide any links to the HFEA rating system. It is crucial to provide patients with clear and accurate information to enable them to make fully informed decisions about TLI, particularly when they are responsible for the associated costs. The findings of this study raise concerns about the reliability and accuracy of the information available on fertility clinic websites, which are typically the primary source of information for patients.

Fertility restoration potential of immature testicular tissue (ITT) depends on the number of spermatogonial cells in the retrieved tissue prior to cryopreservation in oncofertility programme. There are limited data on the association between type of malignancy and testicular germ cell population. Hence, this study is aimed to investigate the spermatogonial and Sertoli cell population in ITT retrieved from 14 pre-pubertal boys who opted for fertility preservation. Histopathological and immunochemical analysis of seminiferous tubules from haematological (N = 7) and non-haematological (N = 7) malignant patients revealed 3.43 ± 2.92 and 1.71 ± 1.81 spermatogonia per tubular cross section (S/T), respectively. The Sertoli cell number was comparable between haematological and non-haematological group (18.42 ± 3.78 and 22.03 ± 10.43). Spermatogonial quantity in ITT did not vary significantly between haematological and non-haematological cancers. This observation, though preliminary, would contribute to the limited literature on paediatric male oncofertility.

Antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) are currently the most sensitive and reliable markers of ovarian reserve, but the role of AFC and AMH, as prognosis markers of diminished ovarian reserve (DOR), in pregnancy outcomes after embryo transfer (ET) have been inconsistent. A retrospective cohort study was conducted in a university-affiliated hospital. A total of 4599 women who received their first IVF treatment between January 2012 and December 2019 were included. Uni- and multi-variable regression models were used to determine the association of DOR evaluated by AFC and AMH with pregnancy, number of ET cycles to pregnancy, live birth, preterm birth, and low birth weight. Among the women included, 380 (8.3%) had DOR (i.e. AFC <5 or AMH <1.2 μg/L). After adjusting for confounders, DOR determined by AFC/AMH, AFC alone and AMH alone was associated with a lower pregnancy rate (Risk ratio [RR] 0.81, 95% confidence interval [CI] 0.73-0.89). Among women who were successfully pregnant, DOR evaluated by AFC/AMH but not evaluated by AFC alone or AMH alone was associated with an increased number of ET cycles to pregnancy (Odds ratio 1.43, 95% CI 1.04-1.96). DOR was not associated with the risks of live birth, low birth weight, and preterm birth. Women with DOR may have more difficulty becoming pregnant after IVF treatment, suggesting the predictive role of DOR in pregnancy outcomes before IVF treatment.

There is a need to understand teenagers' views towards having children to better tailor sexuality and reproductive health education. We conducted a survey of parenthood intentions for 16-18-year-old students. The survey was anonymous, contained open-ended and multiple-choice questions and was live from 10 May 2021 to 18 July 2022. The sample size was n = 931. Quantitative data were analysed descriptively and using chi-squared tests; qualitative data were analysed thematically. The majority of students (64%) indicated they wanted to have children in the future, with 49% desiring to have two children. Students who opted against having children cited the turbulent state of the world, concerns about parenthood, and, for many females, negative associations to pregnancy and childbirth. Many students felt concern about the possibility of having children in the future (45%), expressing concerns about their ability to have healthy children and worries about the lives their children might lead. Six themes were identified in their responses to the question 'What are your concerns about the possibility of having children in the future?': Fears; Self-doubt; Health and wellbeing; Big investment; Hinderance to personal aspirations; and Non-inclusive LGBTQ+ education. We conclude by making recommendations as to how school reproductive health and sex education might be improved.

Deciding whether to transfer a non-euploid embryo presents a challenge for both individuals and clinicians involved in assisted reproductive technologies (ART) with preimplantation genetic testing (PGT). The uncertainty surrounding clinical outcomes and long-term effects complicates this decision, and there is limited research on the factors that influence individuals' experiences during this decision-making process. An online survey was utilized to gather data on elements influencing the decision-making process. The survey included both closed and open questions and targeted individuals worldwide who had undergone PGT during their fertility journey. A total of 135 responses were received, with complete data from 111 respondents analyzed. Three primary factors emerged as significant influences on respondents' decision-making: the opportunity to discuss the implications of the transfer, the topics covered during consultations, and the country where the treatment was received. The study also identified three major themes related to the challenges faced by respondents: mismatched expectations, inadequate information provision, and an unsupportive decision-making process. These results highlight the critical need for appropriate support when deciding to transfer a non-euploid embryo. Respondents emphasized the importance of comprehensive discussions about the implications of PGT results. The study underscores the necessity for proactive clinic communication, patient-centred information, and increased support for patients considering non-euploid embryos.

To establish a predictive model for clinical pregnancy outcomes following the transfer of a single fresh blastocyst in vitro fertilization (IVF). 615 patients (492 in training set and 123 in test set) who underwent the first single and fresh blastocyst transfer in the first IVF or intracytoplasmic sperm injection cycle performed in fertility centre of Shenzhen Zhongshan Obstetrics & Gynecology Hospital from July 2015 to June 2021 were enrolled in this study. Conventional method such as logistic regression (LR), individual machine learning methods including naive bayesian (NB), K-nearest neighbours (K-NN), support vector machine (SVM), decision tree (DT), and ensemble learning methods including random forest (RF), XGBoost, LightGBM, Voting were used to establish the clinical pregnancy outcome prediction model, and the efficacy among different models was compared. Three major types of prediction models, including conventional method: LR (AUC = 0.707), individual machine learning classifiers: NB (AUC = 0.741), K-NN (AUC = 0.719), SVM (AUC = 0.761), DT (AUC = 0.728), ensemble models: RF (AUC = 0.790), XGBoost (AUC = 0.799), LightGBM (AUC = 0.794), Voting (AUC = 0.845) were established. It was found that the performance of the voting model was best. This study revealed that a voting classifier can provide a more accurate estimate of IVF outcome, which can assist clinicians to make individual patient counselling.

This study aimed to evaluate the cumulative live birth rate (cLBR) of progestin-primed ovarian stimulation (PPOS) protocol versus gonadotropin-releasing hormone antagonist (GnRH-ant) protocol for in vitro fertilization (IVF) cycle in infertile women with normal ovarian reserve (NOR). Infertile women with NOR who underwent their first IVF cycle were enrolled in an open-label randomized controlled trial. Patients were randomly assigned 1:1 to receive a freeze-all strategy with delayed embryo transfer (PPOS group, n = 174) and fresh embryo transfer first (GnRH-ant group, n = 174). The primary outcome was the cLBR per aspiration. The cLBR between the PPOS group and GnRH-ant group were comparable (55.75% vs. 52.87%, p = 0.591). A premature luteinizing hormone surge was not observed in the PPOS group, while there were six cases (3.45%) in the GnRH-ant group, but no premature ovulation in either of the groups. The pregnancy outcomes, including implantation rate, clinical pregnancy rate and miscarriage rate, were all comparable. In addition, the number of retrieved oocytes, mature oocytes and viable embryos were similar (all p > 0.05) between the two groups.