Pub Date : 2024-07-03DOI: 10.1186/s43043-024-00195-5
Xianju Huang, Xinle Lu, Xue Jiang, Ludan Chao, Xiao Wang
Previous evidence suggests that low-quality embryos may send negative signals to the endometrium and affect the receptivity of the endometrium. This study aimed to evaluate the influence of transferring an additional low-quality embryo with a high-quality embryo on the pregnancy outcome. A total of 1506 fresh embryo transfer cycles between January 2018 and June 2020 were included. The patients were separated into two groups: a single embryo transfer group (SET, patients receiving a single high-quality embryo) and a double embryo transfer group (DET, patients receiving a high-quality embryo and a low-quality embryo). Main outcome measures including multiple pregnancy rate and live birth rate were discussed. Overall, in the primary analysis, patients who receive an additional low-quality embryo improved the live birth by 8.7% and multiple pregnancy rate by 10.0%. In women aged less than 35 years, compared with SET, DET increased the birth rate by 6.0% but resulted in a 13.5% increase in multiples. Women of 35 years above, adding a low-quality embryo increased the live birth rate by only 2.2% but increased multiples by 14.7%. In patients with one cycle of ET, the same results were obtained. In patients with multiple cycles of ET and adding a low-quality embryo, the live birth rate was similar to SET but with a 14.7% increase in multiples. Compared to DET, we prefer to transfer a high-quality embryo. Nevertheless, in women 35 years or older or in patients with multiple cycles of embryo transfer, adding a low-quality embryo did not significantly improve live birth but increased the multiple rate.
以往的证据表明，低质量胚胎可能会向子宫内膜发出负面信号，影响子宫内膜的接受能力。本研究旨在评估在移植优质胚胎的同时再移植一个低质量胚胎对妊娠结局的影响。共纳入2018年1月至2020年6月期间的1506个新鲜胚胎移植周期。患者被分为两组：单胚胎移植组（SET，接受单个优质胚胎的患者）和双胚胎移植组（DET，接受一个优质胚胎和一个低质量胚胎的患者）。讨论的主要结果指标包括多胎妊娠率和活产率。总体而言，在主要分析中，接受额外低质量胚胎的患者的活产率提高了 8.7%，多胎妊娠率提高了 10.0%。在 35 岁以下的妇女中，与 SET 相比，DET 使出生率提高了 6.0%，但导致多胎妊娠率增加了 13.5%。在 35 岁以上的妇女中，添加低质量胚胎仅使活产率增加 2.2%，但多胎率增加 14.7%。在只进行过一个 ET 周期的患者中，也得到了相同的结果。在进行多个周期 ET 并添加低质量胚胎的患者中，活产率与 SET 相似，但多胞胎增加了 14.7%。与 DET 相比，我们更倾向于移植优质胚胎。然而，对于 35 岁或以上的女性或进行过多个周期胚胎移植的患者，添加低质量胚胎并不能显著提高活产率，反而会增加多胎率。
{"title":"The effect of transferring a low-quality embryo along with a high-quality embryo on the pregnancy outcome","authors":"Xianju Huang, Xinle Lu, Xue Jiang, Ludan Chao, Xiao Wang","doi":"10.1186/s43043-024-00195-5","DOIUrl":"https://doi.org/10.1186/s43043-024-00195-5","url":null,"abstract":"Previous evidence suggests that low-quality embryos may send negative signals to the endometrium and affect the receptivity of the endometrium. This study aimed to evaluate the influence of transferring an additional low-quality embryo with a high-quality embryo on the pregnancy outcome. A total of 1506 fresh embryo transfer cycles between January 2018 and June 2020 were included. The patients were separated into two groups: a single embryo transfer group (SET, patients receiving a single high-quality embryo) and a double embryo transfer group (DET, patients receiving a high-quality embryo and a low-quality embryo). Main outcome measures including multiple pregnancy rate and live birth rate were discussed. Overall, in the primary analysis, patients who receive an additional low-quality embryo improved the live birth by 8.7% and multiple pregnancy rate by 10.0%. In women aged less than 35 years, compared with SET, DET increased the birth rate by 6.0% but resulted in a 13.5% increase in multiples. Women of 35 years above, adding a low-quality embryo increased the live birth rate by only 2.2% but increased multiples by 14.7%. In patients with one cycle of ET, the same results were obtained. In patients with multiple cycles of ET and adding a low-quality embryo, the live birth rate was similar to SET but with a 14.7% increase in multiples. Compared to DET, we prefer to transfer a high-quality embryo. Nevertheless, in women 35 years or older or in patients with multiple cycles of embryo transfer, adding a low-quality embryo did not significantly improve live birth but increased the multiple rate.","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141523318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20DOI: 10.1186/s43043-024-00193-7
Li-Na He, Qing Xu, Jie Lin, Yi Liu, Wei Chen
Accurate prediction of oocyte maturation is a critical determinant of success in in vitro fertilization-embryo transfer (IVF-ET) procedures. This review provides a comprehensive analysis of the various predictive approaches employed to assess oocyte maturity, including single indicators, combined indicators, and predictive models. Factors such as ovarian reserve, patient characteristics, and controlled ovarian hyperstimulation (COH) strategies can significantly influence oocyte maturation rates. Single indicators, including hormone levels, ultrasound parameters, and clinical parameters, have been extensively studied. However, their predictive power may be limited when used in isolation. Combined indicators, integrating multiple parameters, have demonstrated improved predictive performance compared to single indicators. Additionally, predictive models and algorithms, such as machine learning and deep learning models, have emerged as promising tools for assessing oocyte maturity. These models leverage advanced statistical and computational methods to analyze complex datasets and identify patterns that can predict oocyte maturation rates with potentially higher accuracy. Despite these advancements, several gaps and limitations persist, including limited generalizability, lack of standardization, insufficient external validation, and the need to incorporate patient-specific factors and emerging technologies. The review highlights potential areas for further research, such as multicenter collaborative studies, integration of advanced omics technologies, development of personalized prediction models, and investigation of trigger time optimization strategies. Recommendations for clinical practice include utilizing a combination of indicators, adopting validated predictive models, tailoring approaches based on individual patient characteristics, continuous monitoring and adjustment, and fostering multidisciplinary collaboration. Accurate prediction of oocyte maturation holds profound implications for improving the success rates of IVF-ET and enhancing the chances of achieving a healthy pregnancy. Continued research, innovative approaches, and the implementation of evidence-based practices are essential to optimize assisted reproductive outcomes.
{"title":"Predictive strategies for oocyte maturation in IVF cycles: from single indicators to integrated models","authors":"Li-Na He, Qing Xu, Jie Lin, Yi Liu, Wei Chen","doi":"10.1186/s43043-024-00193-7","DOIUrl":"https://doi.org/10.1186/s43043-024-00193-7","url":null,"abstract":"Accurate prediction of oocyte maturation is a critical determinant of success in in vitro fertilization-embryo transfer (IVF-ET) procedures. This review provides a comprehensive analysis of the various predictive approaches employed to assess oocyte maturity, including single indicators, combined indicators, and predictive models. Factors such as ovarian reserve, patient characteristics, and controlled ovarian hyperstimulation (COH) strategies can significantly influence oocyte maturation rates. Single indicators, including hormone levels, ultrasound parameters, and clinical parameters, have been extensively studied. However, their predictive power may be limited when used in isolation. Combined indicators, integrating multiple parameters, have demonstrated improved predictive performance compared to single indicators. Additionally, predictive models and algorithms, such as machine learning and deep learning models, have emerged as promising tools for assessing oocyte maturity. These models leverage advanced statistical and computational methods to analyze complex datasets and identify patterns that can predict oocyte maturation rates with potentially higher accuracy. Despite these advancements, several gaps and limitations persist, including limited generalizability, lack of standardization, insufficient external validation, and the need to incorporate patient-specific factors and emerging technologies. The review highlights potential areas for further research, such as multicenter collaborative studies, integration of advanced omics technologies, development of personalized prediction models, and investigation of trigger time optimization strategies. Recommendations for clinical practice include utilizing a combination of indicators, adopting validated predictive models, tailoring approaches based on individual patient characteristics, continuous monitoring and adjustment, and fostering multidisciplinary collaboration. Accurate prediction of oocyte maturation holds profound implications for improving the success rates of IVF-ET and enhancing the chances of achieving a healthy pregnancy. Continued research, innovative approaches, and the implementation of evidence-based practices are essential to optimize assisted reproductive outcomes.","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"10 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141529897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-04DOI: 10.1186/s43043-024-00190-w
Shehnaz Sultana, B. Divya Bhanu, Venkateshwari Ananthapur
Three or more consecutive pregnancy losses before the 20th week of gestation constitute recurrent pregnancy loss (RPL), and about half of these cases are still unsolved despite routine screening tests. The purpose of the current study was to identify the RPL-related placental decidual differential gene expression and to gain new knowledge about the biological mechanisms underlying RPL. In the current work, we used RNA sequencing (RNA-seq) technology to identify the differentially expressed genes (DEGs) in placental decidua from patients of unexplained recurrent pregnancy loss (RPL). To conduct RNA-seq, two healthy unwanted medically terminated pregnancies (MTPs) and four RPL patients were enlisted. A total number of 96 significant differentially expressed genes (DEGs) were obtained which includes 73 up- and 23 downregulated genes between the RPL and MTP groups. Histocompatibility genes were significantly upregulated in the RPL. Interleukin 6 (IL-6), matrix metalloproteinase-10 (MMP10), and protein phosphatase 1 regulatory inhibitor subunit 11 (PPP1R11) genes which were significantly upregulated in RPL were further validated in an extended sample size. The validation results were consistent with the sequencing results. To find potential biological pathways connected to RPL, the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were carried out. The study indicates that arginine biosynthesis is significantly downregulated, while IL-17 signalling pathway is significantly upregulated in RPL. In conclusion, the findings of the present study indicate involvement of arginine biosynthesis, immune regulatory pathways, and histocompatibility genes in the pathogenesis of recurrent pregnancy loss (RPL). However, to validate these observations, further investigations with a larger sample size are warranted.
{"title":"Identification of key functional pathways: arginine biosynthesis and IL-17 signalling in placental decidua of unexplained recurrent pregnancy loss through RNA sequencing—a case series","authors":"Shehnaz Sultana, B. Divya Bhanu, Venkateshwari Ananthapur","doi":"10.1186/s43043-024-00190-w","DOIUrl":"https://doi.org/10.1186/s43043-024-00190-w","url":null,"abstract":"Three or more consecutive pregnancy losses before the 20th week of gestation constitute recurrent pregnancy loss (RPL), and about half of these cases are still unsolved despite routine screening tests. The purpose of the current study was to identify the RPL-related placental decidual differential gene expression and to gain new knowledge about the biological mechanisms underlying RPL. In the current work, we used RNA sequencing (RNA-seq) technology to identify the differentially expressed genes (DEGs) in placental decidua from patients of unexplained recurrent pregnancy loss (RPL). To conduct RNA-seq, two healthy unwanted medically terminated pregnancies (MTPs) and four RPL patients were enlisted. A total number of 96 significant differentially expressed genes (DEGs) were obtained which includes 73 up- and 23 downregulated genes between the RPL and MTP groups. Histocompatibility genes were significantly upregulated in the RPL. Interleukin 6 (IL-6), matrix metalloproteinase-10 (MMP10), and protein phosphatase 1 regulatory inhibitor subunit 11 (PPP1R11) genes which were significantly upregulated in RPL were further validated in an extended sample size. The validation results were consistent with the sequencing results. To find potential biological pathways connected to RPL, the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were carried out. The study indicates that arginine biosynthesis is significantly downregulated, while IL-17 signalling pathway is significantly upregulated in RPL. In conclusion, the findings of the present study indicate involvement of arginine biosynthesis, immune regulatory pathways, and histocompatibility genes in the pathogenesis of recurrent pregnancy loss (RPL). However, to validate these observations, further investigations with a larger sample size are warranted.","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"71 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141257558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-31DOI: 10.1186/s43043-024-00191-9
Anastasia A. Salame, Mokhamad J. Zhaffal, Braulio Peramo
Human reproduction is an imperfect process despite years of evolution. It is estimated that only 30% of conceived pregnancies end up with a live birth (Hum Reprod Update 8:333-343, 2002). Although the IVF cycle clinical pregnancy rate is estimated to be above 60%, the actual live birth rate is still well below 50% (Reprod Biomed Online 40:201-206, 2004). Errors of implantation, embryonic genetic mutations, structural as well as chromosomal abnormalities, endometrial aberrances as well as abnormal sites of implantation are all conditions that could be associated with a positive pregnancy test yet a non-viable pregnancy outcome. In this extensive literature review, we detailed the different risk factors hindering a successful reproductive outcome post-IVF in terms of early pregnancy loss. We also reviewed the different treatment modalities available to improve the prognosis of such patients.
{"title":"Early pregnancy loss in IVF: a literature review","authors":"Anastasia A. Salame, Mokhamad J. Zhaffal, Braulio Peramo","doi":"10.1186/s43043-024-00191-9","DOIUrl":"https://doi.org/10.1186/s43043-024-00191-9","url":null,"abstract":"Human reproduction is an imperfect process despite years of evolution. It is estimated that only 30% of conceived pregnancies end up with a live birth (Hum Reprod Update 8:333-343, 2002). Although the IVF cycle clinical pregnancy rate is estimated to be above 60%, the actual live birth rate is still well below 50% (Reprod Biomed Online 40:201-206, 2004). Errors of implantation, embryonic genetic mutations, structural as well as chromosomal abnormalities, endometrial aberrances as well as abnormal sites of implantation are all conditions that could be associated with a positive pregnancy test yet a non-viable pregnancy outcome. In this extensive literature review, we detailed the different risk factors hindering a successful reproductive outcome post-IVF in terms of early pregnancy loss. We also reviewed the different treatment modalities available to improve the prognosis of such patients.","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"20 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141193968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-31DOI: 10.1186/s43043-024-00185-7
Mahmoud Zakherah, Ahmed A. Mohamed, Abdulrahman M. Rageh, Mahmoud Abdel-aleem
The increasing prevalence of cesarean section (CS) deliveries globally has sparked apprehension regarding potential long-term complications, notably the emergence of uterine niches. CS results in a scar that in certain patients, inadequate healing of that scar results in the development of a uterine niche. While most small niches show no symptoms, large cesarean scar niches in nonpregnant women can give rise to cesarean scar disorder syndrome. This syndrome is characterized by abnormal uterine bleeding, dysmenorrhea, and secondary infertility. In pregnant women, the presence of substantial niches may be linked to potentially life-threatening complications, including cesarean scar dehiscence, uterine rupture, placenta accreta spectrum disorders, placenta previa, and cesarean scar ectopic pregnancy. Given the potential dangers associated with uterine niche occurrence, numerous studies in recent years have delved into the concept of cesarean scar niche, exploring its risk factors, diagnostic approaches, and treatment options. Various diagnostic modalities, such as two- or three-dimensional transvaginal ultrasonography, two- and three-dimensional sono-hysterography, hysterosalpingography, hysteroscopy, or magnetic resonance imaging, can be employed to detect uterine niches. However, none of these diagnostic methods is universally accepted as the “gold standard,” and there remains a lack of unequivocal guidelines on certain aspects related to the diagnosis of cesarean scar niche. These niches, characterized by hypoechoic regions within the myometrium at the site of a previous CS scar, pose diagnostic complexities and provoke inquiries into their prevalence, factors influencing their development, clinical presentations, and appropriate therapeutic approaches. As CS rates rise, this review aims to understand and address uterine niches and mitigate their impact on maternal health and reproductive outcomes.
{"title":"Navigating uterine niche 360 degree: a narrative review","authors":"Mahmoud Zakherah, Ahmed A. Mohamed, Abdulrahman M. Rageh, Mahmoud Abdel-aleem","doi":"10.1186/s43043-024-00185-7","DOIUrl":"https://doi.org/10.1186/s43043-024-00185-7","url":null,"abstract":"The increasing prevalence of cesarean section (CS) deliveries globally has sparked apprehension regarding potential long-term complications, notably the emergence of uterine niches. CS results in a scar that in certain patients, inadequate healing of that scar results in the development of a uterine niche. While most small niches show no symptoms, large cesarean scar niches in nonpregnant women can give rise to cesarean scar disorder syndrome. This syndrome is characterized by abnormal uterine bleeding, dysmenorrhea, and secondary infertility. In pregnant women, the presence of substantial niches may be linked to potentially life-threatening complications, including cesarean scar dehiscence, uterine rupture, placenta accreta spectrum disorders, placenta previa, and cesarean scar ectopic pregnancy. Given the potential dangers associated with uterine niche occurrence, numerous studies in recent years have delved into the concept of cesarean scar niche, exploring its risk factors, diagnostic approaches, and treatment options. Various diagnostic modalities, such as two- or three-dimensional transvaginal ultrasonography, two- and three-dimensional sono-hysterography, hysterosalpingography, hysteroscopy, or magnetic resonance imaging, can be employed to detect uterine niches. However, none of these diagnostic methods is universally accepted as the “gold standard,” and there remains a lack of unequivocal guidelines on certain aspects related to the diagnosis of cesarean scar niche. These niches, characterized by hypoechoic regions within the myometrium at the site of a previous CS scar, pose diagnostic complexities and provoke inquiries into their prevalence, factors influencing their development, clinical presentations, and appropriate therapeutic approaches. As CS rates rise, this review aims to understand and address uterine niches and mitigate their impact on maternal health and reproductive outcomes.","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"48 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141193992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29DOI: 10.1186/s43043-024-00186-6
Li-fan Peng, Hang Yu
Spermatogenesis was crucial for adult male animals to achieve reproductive function, and this complex physiological process required timely and moderate expression of related genes. A large number of epigenetic regulatory factors were involved, including cyclic RNA. Circular RNA had various characteristics such as rich expression, evolutionary conservation, cell or tissue specificity, and higher resistance to exonuclease or ribonuclease degradation. It can regulate the expression of parental genes and function as mRNA traps, miRNAs, or proteins in the corpus cavernous; it can also participate in the process of spermatogenesis through RNA-binding proteins, including the formation of reproductive stem cells, sperm formation, seminal plasma composition, and testicular tissue formation.
{"title":"Circular RNA regulates male spermatogenesis: a narrative review","authors":"Li-fan Peng, Hang Yu","doi":"10.1186/s43043-024-00186-6","DOIUrl":"https://doi.org/10.1186/s43043-024-00186-6","url":null,"abstract":"Spermatogenesis was crucial for adult male animals to achieve reproductive function, and this complex physiological process required timely and moderate expression of related genes. A large number of epigenetic regulatory factors were involved, including cyclic RNA. Circular RNA had various characteristics such as rich expression, evolutionary conservation, cell or tissue specificity, and higher resistance to exonuclease or ribonuclease degradation. It can regulate the expression of parental genes and function as mRNA traps, miRNAs, or proteins in the corpus cavernous; it can also participate in the process of spermatogenesis through RNA-binding proteins, including the formation of reproductive stem cells, sperm formation, seminal plasma composition, and testicular tissue formation.","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"37 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141193714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29DOI: 10.1186/s43043-024-00189-3
Maha Katta, Ahmed M. Maged, Asmaa I. Ogila, Wael S. Ragab
Treatment of endometrioma before in vitro fertilization (IVF) is challenging as it may affect ovarian response to induction. A systematic review to search for the available optimal management of ovarian endometrioma before ovulation induction in IVF. Screening of the MEDLINE, Web of Science, EMBASE, Cochrane database, and the clinical trial registration sites, covering the period from their inception up to June 2023 was done by two reviewers independently using the keywords ovarian endometrioma, ovarian endometriosis, endometrioma/surgery, endometrioma/hormonal treatment, randomized controlled trial(s), case-controlled studies, and cohort studies. All types of studies were included. Participants included were women with unilateral or bilateral ovarian endometriomas candidate for IVF/ICSI. We included 18 studies in the review. Three studies were randomized controlled parallel studies, six were prospective cohort, and nine were retrospective cohort studies. Data from all included studies were extracted by two authors (A. M., A. O.) independently. Data extracted included sample size, population characteristics including age, BMI, duration of infertility, ovarian reserve markers, cyst size, and bilaterality and induction protocol used. We found 18 studies. Women with untreated endometrioma had significantly higher numbers of MII oocytes (the mean difference (MD) effect estimate was − 0.53 with [− 1.04, − 0.01] 95% CI and 0.04 P-value), higher number of obtained embryos (MD effect estimate was − 0.25 with [− 0.38, − 0.11] 95%CI and < 0.001 P-value), and required lower doses of gonadotropins for induction (MD effect estimate was 361.14 with [168.13, 5554.15] 95% CI and < 0.001 P-value) compared to those who had undergone surgical management of endometrioma. However, live birth (OR effect estimate was 0.79 with [0.54, 1.18] 95% CI and 0.25 P-value), clinical pregnancy (OR effect estimate was 0.95 with [0.72, 1.26] 95% CI and 0.73 P-value), miscarriage (OR effect estimate was 0.74 with [0.33, 1.63] 95% CI and 0.45 P-value), cancellation rates (OR effect estimate was 1.62 with [0.57, 4.66] 95% CI and 0.37 P-value), and the duration of stimulation (MD effect estimate was 0.19 with [− 0.42, − 0.81] 95% CI and 0.54 P-value) did not show any significant difference between the two groups of women. Hormonal treatment of endometrioma was associated with higher ongoing pregnancy rate (OR effect estimate was 3.39 with [1.83, 6.26] 95% CI and < 0.001 P-value), higher clinical pregnancy rate (OR effect estimate was 3.36 with [2.01, 5.63] 95% CI and < 0.001 P-value), and higher numbers of MII oocytes (MD effect estimate was 2.04 with [0.72, 3.36] 95% CI and 0.003 P-value) when compared to women who did not receive such therapy. These effects were evident in treatment with GnRH agonists, OCPs (oral contraceptive pills), and dienogest, while the miscarriage and cycle cancellation rates did not show these differences. The optimal approach for treating endometrioma prior
体外受精（IVF）前治疗子宫内膜异位症具有挑战性，因为它可能会影响卵巢对促排卵的反应。一项系统综述旨在寻找试管婴儿促排卵前卵巢子宫内膜异位症的最佳治疗方法。由两名审稿人独立使用卵巢子宫内膜异位症、卵巢子宫内膜异位症、子宫内膜异位症/手术、子宫内膜异位症/激素治疗、随机对照试验、病例对照研究和队列研究等关键词，对 MEDLINE、Web of Science、EMBASE、Cochrane 数据库和临床试验注册网站进行筛选，筛选时间从开始至 2023 年 6 月。所有类型的研究均包括在内。研究对象为患有单侧或双侧卵巢子宫内膜异位症、准备接受体外受精/卵胞浆内单精子显微注射的女性。我们共纳入了 18 项研究。其中 3 项为随机对照平行研究，6 项为前瞻性队列研究，9 项为回顾性队列研究。所有纳入研究的数据均由两位作者（A. M. 和 A. O.）独立提取。提取的数据包括样本大小、人群特征（包括年龄、体重指数、不孕持续时间、卵巢储备指标、囊肿大小、双侧卵巢和所使用的诱导方案）。我们发现了 18 项研究。未经治疗的子宫内膜异位症妇女的 MII 卵母细胞数量明显较多（平均差（MD）效应估计值为 - 0.53，95% CI 为 [- 1.04, - 0.01] ，P 值为 0.04），获得的胚胎数量较多（MD效应估计值为 - 0.25，[- 0.38，- 0.11] 95%CI 和 < 0.001 P-值），并且与接受子宫内膜异位症手术治疗的患者相比，需要更低剂量的促性腺激素进行诱导（MD 效果估计值为 361.14，[168.13，5554.15] 95% CI 和 < 0.001 P-值）。然而，活产（OR 效果估计值为 0.79，[0.54, 1.18] 95% CI 和 0.25 P-值）、临床妊娠（OR 效果估计值为 0.95，[0.72, 1.26] 95% CI 和 0.73 P-值）、流产（OR 效果估计值为 0.74，[0.33, 1.63] 95% CI 和 0.45 P-值）、流产率（OR 效果估计值为 1.62，[0.57, 4.66] 95% CI 和 0.37 P-值）和刺激持续时间（MD 效果估计值为 0.19，[- 0.42, - 0.81] 95% CI 和 0.54 P-值）在两组妇女之间没有显示出任何显著差异。与未接受激素治疗的妇女相比，子宫内膜异位症激素治疗与较高的持续妊娠率（OR 效果估计值为 3.39，[1.83, 6.26] 95% CI 和 < 0.001 P-值）、较高的临床妊娠率（OR 效果估计值为 3.36，[2.01, 5.63] 95% CI 和 < 0.001 P-值）和较高的 MII 卵母细胞数量（MD 效果估计值为 2.04，[0.72, 3.36] 95% CI 和 0.003 P-值）相关。这些效应在使用 GnRH 促效剂、OCP（口服避孕药）和地诺孕酮治疗时非常明显，而流产率和周期取消率则没有显示出这些差异。由于缺乏设计良好的随机对照试验，体外受精前治疗子宫内膜异位症的最佳方法尚不明确。CRD42020151736。
{"title":"Impact of treatment interventions of endometriomas prior to in vitro fertilization: a systematic review and meta-analysis","authors":"Maha Katta, Ahmed M. Maged, Asmaa I. Ogila, Wael S. Ragab","doi":"10.1186/s43043-024-00189-3","DOIUrl":"https://doi.org/10.1186/s43043-024-00189-3","url":null,"abstract":"Treatment of endometrioma before in vitro fertilization (IVF) is challenging as it may affect ovarian response to induction. A systematic review to search for the available optimal management of ovarian endometrioma before ovulation induction in IVF. Screening of the MEDLINE, Web of Science, EMBASE, Cochrane database, and the clinical trial registration sites, covering the period from their inception up to June 2023 was done by two reviewers independently using the keywords ovarian endometrioma, ovarian endometriosis, endometrioma/surgery, endometrioma/hormonal treatment, randomized controlled trial(s), case-controlled studies, and cohort studies. All types of studies were included. Participants included were women with unilateral or bilateral ovarian endometriomas candidate for IVF/ICSI. We included 18 studies in the review. Three studies were randomized controlled parallel studies, six were prospective cohort, and nine were retrospective cohort studies. Data from all included studies were extracted by two authors (A. M., A. O.) independently. Data extracted included sample size, population characteristics including age, BMI, duration of infertility, ovarian reserve markers, cyst size, and bilaterality and induction protocol used. We found 18 studies. Women with untreated endometrioma had significantly higher numbers of MII oocytes (the mean difference (MD) effect estimate was − 0.53 with [− 1.04, − 0.01] 95% CI and 0.04 P-value), higher number of obtained embryos (MD effect estimate was − 0.25 with [− 0.38, − 0.11] 95%CI and < 0.001 P-value), and required lower doses of gonadotropins for induction (MD effect estimate was 361.14 with [168.13, 5554.15] 95% CI and < 0.001 P-value) compared to those who had undergone surgical management of endometrioma. However, live birth (OR effect estimate was 0.79 with [0.54, 1.18] 95% CI and 0.25 P-value), clinical pregnancy (OR effect estimate was 0.95 with [0.72, 1.26] 95% CI and 0.73 P-value), miscarriage (OR effect estimate was 0.74 with [0.33, 1.63] 95% CI and 0.45 P-value), cancellation rates (OR effect estimate was 1.62 with [0.57, 4.66] 95% CI and 0.37 P-value), and the duration of stimulation (MD effect estimate was 0.19 with [− 0.42, − 0.81] 95% CI and 0.54 P-value) did not show any significant difference between the two groups of women. Hormonal treatment of endometrioma was associated with higher ongoing pregnancy rate (OR effect estimate was 3.39 with [1.83, 6.26] 95% CI and < 0.001 P-value), higher clinical pregnancy rate (OR effect estimate was 3.36 with [2.01, 5.63] 95% CI and < 0.001 P-value), and higher numbers of MII oocytes (MD effect estimate was 2.04 with [0.72, 3.36] 95% CI and 0.003 P-value) when compared to women who did not receive such therapy. These effects were evident in treatment with GnRH agonists, OCPs (oral contraceptive pills), and dienogest, while the miscarriage and cycle cancellation rates did not show these differences. The optimal approach for treating endometrioma prior","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"11 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141172197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Considering the growing therapeutic use of cannabidiol as well as the presence of cannabinoid receptors in sperm and its possible genotoxic activity, the effect of cannabidiol on sperm quality and function was examined. Thirty male NMRI mice were randomly divided into three groups: control (no injection), sham (intraperitoneal (IP) injection of DMSO daily for 34 days), and cannabidiol (IP injection of cannabidiol 30 mg/ml daily for 34 days). Following 35 days after the last injection, sperm parameters, chromatin integrity (CMA3 staining), acrosome reaction (FITC-PNA method), fertility-related genes (IZUMO1, PLCζ), and blastulation rate of the embryos obtained from the oocytes fertilized with the mentioned sperms was investigated. Count, motility, and morphology of sperm were not significantly affected by cannabidiol. CMA3+ sperms (protamine deficiency) were significantly higher in the cannabidiol group compared to the control group (P = 0.03). The acrosomal reaction and fertility-related genes (IZUMO1, PLCζ) in the cannabidiol group did not differ significantly compared to the control group. Also, there was no significant difference between the cannabidiol group and the control group in the two-cell and the eight-cell stages but the rate of blastocyst formation was significantly lower in the cannabidiol group compared to other groups (P < 0.0001). Our results showed that cannabidiol leads to negative effects on the male reproductive system through an effect on sperm chromatin and the rate of reaching the blastocyst stage of the embryo.
{"title":"Cannabidiol impairs sperm quality and function in adult mice","authors":"Azam Govahi, Sahar Eghbali, Marziyeh Ajdary, Fatemehsadat Amjadi, Mahsa Nazari, Farzaneh Mohammadzadeh Kazorgah, Mehdi Mehdizadeh","doi":"10.1186/s43043-024-00184-8","DOIUrl":"https://doi.org/10.1186/s43043-024-00184-8","url":null,"abstract":"Considering the growing therapeutic use of cannabidiol as well as the presence of cannabinoid receptors in sperm and its possible genotoxic activity, the effect of cannabidiol on sperm quality and function was examined. Thirty male NMRI mice were randomly divided into three groups: control (no injection), sham (intraperitoneal (IP) injection of DMSO daily for 34 days), and cannabidiol (IP injection of cannabidiol 30 mg/ml daily for 34 days). Following 35 days after the last injection, sperm parameters, chromatin integrity (CMA3 staining), acrosome reaction (FITC-PNA method), fertility-related genes (IZUMO1, PLCζ), and blastulation rate of the embryos obtained from the oocytes fertilized with the mentioned sperms was investigated. Count, motility, and morphology of sperm were not significantly affected by cannabidiol. CMA3+ sperms (protamine deficiency) were significantly higher in the cannabidiol group compared to the control group (P = 0.03). The acrosomal reaction and fertility-related genes (IZUMO1, PLCζ) in the cannabidiol group did not differ significantly compared to the control group. Also, there was no significant difference between the cannabidiol group and the control group in the two-cell and the eight-cell stages but the rate of blastocyst formation was significantly lower in the cannabidiol group compared to other groups (P < 0.0001). Our results showed that cannabidiol leads to negative effects on the male reproductive system through an effect on sperm chromatin and the rate of reaching the blastocyst stage of the embryo. ","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141172228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-18DOI: 10.1186/s43043-024-00183-9
Rahana Harjee, Jalila Devji, Ella Katelyn Barrett-Chan, Jas Khinda, Mohamed A. Bedaiwy
Caesarean scar disorders (CSDi) are an increasingly recognized consequence of caesarean sections, which can present with secondary infertility. Currently, there is limited data on the management of CSDi, and the subsequent fertility and pregnancy outcomes. Our aim was to examine different treatment methods and outcomes in a cohort of women with secondary infertility. This study involved a retrospective case series for patients (n = 26) diagnosed with and treated for a CSDi between 2008 and 2019 at a tertiary care centre in British Columbia, Canada, by one of three gynecologists with expertise in CSDi repair. Surgical repair was performed via laparoscopy for residual myometrial thickness (RMT) < 3.0 mm, and via hysteroscopy otherwise. Postoperative pregnancy rates and reproductive outcomes are reported. This study also included a search of the literature to gain an overview of the indications, outcomes, advantages, disadvantages, and risks associated with four surgical approaches (hysteroscopic, laparoscopic, vaginal, abdominal) used in the management of CSDi. A Medline and manual searches of referenced articles were conducted for this purpose. Twenty-six patients with CSDi were diagnosed with secondary infertility (mean age = 36.4 years) during the study period. Twenty of these patients underwent surgical management, with 12 receiving hysteroscopic resection or ablation, and 8 receiving laparoscopic repair. Six patients had no treatment or are still awaiting management at this time. Postoperatively, 11/20 patients (55%) were able to successfully conceive at least once. 8/11 patients were from the hysteroscopy group (66% pregnancy rate) and 10/11 pregnancies resulted in live births at term. In the laparoscopy group, there were 3 pregnancies (37.5% pregnancy rate), including 2 term live births, and 1 preterm live birth at 26 weeks. With respect to our review of the literature, a total of 49 articles were included in our final review of surgical techniques used in the management of CSDi. This study suggests that surgical repair can improve pregnancy rates in patients with secondary infertility in the context of a confirmed CSDi.
{"title":"Surgical management of caesarean scar disorder using different techniques: a scoping review and case series","authors":"Rahana Harjee, Jalila Devji, Ella Katelyn Barrett-Chan, Jas Khinda, Mohamed A. Bedaiwy","doi":"10.1186/s43043-024-00183-9","DOIUrl":"https://doi.org/10.1186/s43043-024-00183-9","url":null,"abstract":"Caesarean scar disorders (CSDi) are an increasingly recognized consequence of caesarean sections, which can present with secondary infertility. Currently, there is limited data on the management of CSDi, and the subsequent fertility and pregnancy outcomes. Our aim was to examine different treatment methods and outcomes in a cohort of women with secondary infertility. This study involved a retrospective case series for patients (n = 26) diagnosed with and treated for a CSDi between 2008 and 2019 at a tertiary care centre in British Columbia, Canada, by one of three gynecologists with expertise in CSDi repair. Surgical repair was performed via laparoscopy for residual myometrial thickness (RMT) < 3.0 mm, and via hysteroscopy otherwise. Postoperative pregnancy rates and reproductive outcomes are reported. This study also included a search of the literature to gain an overview of the indications, outcomes, advantages, disadvantages, and risks associated with four surgical approaches (hysteroscopic, laparoscopic, vaginal, abdominal) used in the management of CSDi. A Medline and manual searches of referenced articles were conducted for this purpose. Twenty-six patients with CSDi were diagnosed with secondary infertility (mean age = 36.4 years) during the study period. Twenty of these patients underwent surgical management, with 12 receiving hysteroscopic resection or ablation, and 8 receiving laparoscopic repair. Six patients had no treatment or are still awaiting management at this time. Postoperatively, 11/20 patients (55%) were able to successfully conceive at least once. 8/11 patients were from the hysteroscopy group (66% pregnancy rate) and 10/11 pregnancies resulted in live births at term. In the laparoscopy group, there were 3 pregnancies (37.5% pregnancy rate), including 2 term live births, and 1 preterm live birth at 26 weeks. With respect to our review of the literature, a total of 49 articles were included in our final review of surgical techniques used in the management of CSDi. This study suggests that surgical repair can improve pregnancy rates in patients with secondary infertility in the context of a confirmed CSDi.","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"125 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141061474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-11DOI: 10.1186/s43043-024-00180-y
Prashanth K. Adiga, Nicola Marconi, Ravishankar N, Srisailesh Vitthala
POR or POI poses a significant challenge to fertility treatment with different ovarian stimulation strategies. Intra-ovarian injection of platelet-rich plasma (PRP) has been hypothesised to improve ovarian reserve and pregnancies in POI or POR. However, its effectiveness on pregnancy, embryology and ovarian reserve outcomes need to be established. Therefore, we systematically searched databases based on PRISMA guidelines that reported on the effects of intra-ovarian autologous PRP injections in sub-fertile women with POI and POR. The following outcome effects were analysed by random model and included in the meta-analysis in pre- and post-PRP injection groups of POI & POR: (a) pregnancy rates, rate of oocyte & embryo formation (b) ovarian reserve markers (Antral follicular count, Anti-Mullerian Hormone, Follicle Stimulating Hormone). A separate analysis of pregnancies, AFC and AMH was done in POI and POR groups and in age groups < 35 years and > 35 years. A total of 12 studies were included. The estimated overall effects size of the log odds ratio (log OR = 2.03; 95% CI = 0.13 to 3.92; P = 0.04; I2 = 0.42) favoured post-PRP with a moderate level of evidence. There are no significant differences in POI/POR and those with < 35 years or > 35 years. The pooled standard difference of means favoured the post-PRP injection group significantly with regards to rates of embryo formation (1.39; 95% CI = 0.56 to 2.21; P = 0.02; I2 = 46%.), Oocyte (0.84; 95% CI = -1.3 to 3.0; P = 0.24; I 2 93%), Antral follicle count (1.78; 95% CI = 0.73 to 2.84; P = 0.01. I2 = 97%) with a low level of evidence and Anti-Mullerian Hormone (1.11; 95% CI = 0.16 to 2.05; P = 0.03; I2 = 96%) with low level of evidence. Our study shows that intraovarian PRP injection was associated with no significant increase in the rates of pregnancy, in the rates of pregnancy, oocyte, embryo formation, Anti-Mullerian Hormone and antral follicle count. Live birth rates were not calculated. There was no statistical difference between POR/POI and those with < 35 years or > 35 years. Further randomized studies are warranted to confirm our findings.
POR或POI对采用不同卵巢刺激策略的生育治疗构成了巨大挑战。卵巢内注射富血小板血浆（PRP）被认为可改善 POI 或 POR 的卵巢储备和妊娠。然而，其对妊娠、胚胎学和卵巢储备结果的有效性还有待证实。因此，我们根据 PRISMA 指南，系统地检索了对患有 POI 和 POR 的亚健康女性进行卵巢内自体 PRP 注射的效果进行报道的数据库。荟萃分析采用随机模型对 POI 和 POR 注射前后两组的下列结果效应进行了分析：（a）妊娠率、卵母细胞和胚胎形成率（b）卵巢储备指标（前卵泡计数、抗穆勒氏管激素、卵泡刺激素）。对 POI 组和 POR 组以及 35 岁年龄组的妊娠、AFC 和 AMH 进行了单独分析。共纳入了 12 项研究。估计的总效应对数比（log OR = 2.03; 95% CI = 0.13 to 3.92; P = 0.04; I2 = 0.42）倾向于后PRP，证据等级为中等。POI/POR与35岁以上者无明显差异。在胚胎形成率（1.39；95% CI = 0.56 至 2.21；P = 0.02；I2 = 46%）、卵母细胞（0.84；95% CI = -1.3 至 3.0；P = 0.24; I 2 93%）、前卵泡计数（1.78; 95% CI = 0.73 to 2.84; P = 0.01. I2 = 97%）证据水平较低，抗苗勒氏管激素（1.11; 95% CI = 0.16 to 2.05; P = 0.03; I2 = 96%）证据水平较低。我们的研究表明，卵巢内注射 PRP 与妊娠率、妊娠率、卵母细胞率、胚胎形成率、抗穆勒氏激素和前卵泡数无显著相关性。活产率没有计算在内。POR/POI与 35 岁者之间没有统计学差异。需要进一步的随机研究来证实我们的发现。
{"title":"Effect of intra-ovarian injection of platelet-rich plasma on the patients with a poor ovarian response (POR) or premature ovarian insufficiency (POI): a systematic review and meta-analysis","authors":"Prashanth K. Adiga, Nicola Marconi, Ravishankar N, Srisailesh Vitthala","doi":"10.1186/s43043-024-00180-y","DOIUrl":"https://doi.org/10.1186/s43043-024-00180-y","url":null,"abstract":"POR or POI poses a significant challenge to fertility treatment with different ovarian stimulation strategies. Intra-ovarian injection of platelet-rich plasma (PRP) has been hypothesised to improve ovarian reserve and pregnancies in POI or POR. However, its effectiveness on pregnancy, embryology and ovarian reserve outcomes need to be established. Therefore, we systematically searched databases based on PRISMA guidelines that reported on the effects of intra-ovarian autologous PRP injections in sub-fertile women with POI and POR. The following outcome effects were analysed by random model and included in the meta-analysis in pre- and post-PRP injection groups of POI & POR: (a) pregnancy rates, rate of oocyte & embryo formation (b) ovarian reserve markers (Antral follicular count, Anti-Mullerian Hormone, Follicle Stimulating Hormone). A separate analysis of pregnancies, AFC and AMH was done in POI and POR groups and in age groups < 35 years and > 35 years. A total of 12 studies were included. The estimated overall effects size of the log odds ratio (log OR = 2.03; 95% CI = 0.13 to 3.92; P = 0.04; I2 = 0.42) favoured post-PRP with a moderate level of evidence. There are no significant differences in POI/POR and those with < 35 years or > 35 years. The pooled standard difference of means favoured the post-PRP injection group significantly with regards to rates of embryo formation (1.39; 95% CI = 0.56 to 2.21; P = 0.02; I2 = 46%.), Oocyte (0.84; 95% CI = -1.3 to 3.0; P = 0.24; I 2 93%), Antral follicle count (1.78; 95% CI = 0.73 to 2.84; P = 0.01. I2 = 97%) with a low level of evidence and Anti-Mullerian Hormone (1.11; 95% CI = 0.16 to 2.05; P = 0.03; I2 = 96%) with low level of evidence. Our study shows that intraovarian PRP injection was associated with no significant increase in the rates of pregnancy, in the rates of pregnancy, oocyte, embryo formation, Anti-Mullerian Hormone and antral follicle count. Live birth rates were not calculated. There was no statistical difference between POR/POI and those with < 35 years or > 35 years. Further randomized studies are warranted to confirm our findings.","PeriodicalId":18532,"journal":{"name":"Middle East Fertility Society Journal","volume":"66 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140941938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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