Pub Date : 2024-08-03DOI: 10.1016/j.rbmo.2024.104378
Evrim Unsal , Suleyman Aktuna , Berna Arda , Basak Balaban , Volkan Baltaci , Asina Bayram , Gurkan Bozdag , Zafer Nihat Candan , Murat Cetinkaya , Serdar Ceylaner , Necati Findikli , Hale Goksever Celik , Cihan Halicigil , Semra Kahraman , Metin Kayacaglayan , Ipek Keles , Ayse Kurtoglu , Aylin Mutlu , Gulay Ozgon , Yavuz Emre Sukur , Baris Ata
This guideline was prepared by the Turkish Society of Reproductive Medicine to define the conditions and requirements for an outsourced preimplantation genetic testing (PGT) programme in line with the experience and needs of practitioners. This guideline is intended to be a reference document for assisted reproductive technology centres, genetic diagnosis centres, non-governmental organizations working on reproductive health, legal experts, consultants working on laboratory accreditation, academicians specializing in ethical issues, and policy makers. The Consortium aims to provide recommendations addressing the challenges of genetic testing, especially PGT for monogenic diseases (PGT-M) due to the high rate of consanguineous marriage in Turkey. For this purpose, this summary document specifically includes challenges and recommendations regarding PGT-M practice, and aims to identify and aid in prevention of errors leading to misdiagnosis. The recommendations can be modified to fit other locations.
{"title":"Good laboratory practice for PGT-M: Turkish Society of Reproductive Medicine guidelines","authors":"Evrim Unsal , Suleyman Aktuna , Berna Arda , Basak Balaban , Volkan Baltaci , Asina Bayram , Gurkan Bozdag , Zafer Nihat Candan , Murat Cetinkaya , Serdar Ceylaner , Necati Findikli , Hale Goksever Celik , Cihan Halicigil , Semra Kahraman , Metin Kayacaglayan , Ipek Keles , Ayse Kurtoglu , Aylin Mutlu , Gulay Ozgon , Yavuz Emre Sukur , Baris Ata","doi":"10.1016/j.rbmo.2024.104378","DOIUrl":"10.1016/j.rbmo.2024.104378","url":null,"abstract":"<div><div>This guideline was prepared by the Turkish Society of Reproductive Medicine to define the conditions and requirements for an outsourced preimplantation genetic testing (PGT) programme in line with the experience and needs of practitioners. This guideline is intended to be a reference document for assisted reproductive technology centres, genetic diagnosis centres, non-governmental organizations working on reproductive health, legal experts, consultants working on laboratory accreditation, academicians specializing in ethical issues, and policy makers. The Consortium aims to provide recommendations addressing the challenges of genetic testing, especially PGT for monogenic diseases (PGT-M) due to the high rate of consanguineous marriage in Turkey. For this purpose, this summary document specifically includes challenges and recommendations regarding PGT-M practice, and aims to identify and aid in prevention of errors leading to misdiagnosis. The recommendations can be modified to fit other locations.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 6","pages":"Article 104378"},"PeriodicalIF":3.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S1472-6483(24)00520-0
{"title":"Inside Front Cover - Affiliations and First page of TOC","authors":"","doi":"10.1016/S1472-6483(24)00520-0","DOIUrl":"10.1016/S1472-6483(24)00520-0","url":null,"abstract":"","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 2","pages":"Article 104331"},"PeriodicalIF":3.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1472648324005200/pdfft?md5=0965aebe2baaef6a0e168375f2fecf7e&pid=1-s2.0-S1472648324005200-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1016/j.rbmo.2024.104383
Barbara Lawrenz , Baris Ata , Human M. Fatemi
An early follicular phase start of ovarian stimulation in assisted reproductive technology (ART) is only required if a fresh embryo transfer is planned. A shift from fresh to frozen embryo transfers has recently characterized ART treatments and, combined with the trend towards treatment individualization and simplification, facilitated random-start stimulation. Luteal phase stimulation, started between ovulation and the next menses, has gained momentum and the good, the bad and the ugly sides have become obvious with the increasing number performed. Unprotected intercourse during the follicular phase or around ovulation can result in an unknown and undetectable conception at the time of starting stimulation. Aside from the theoretical implications for embryo development from exposure to stimulation medication, embryo-derived human chorionic gonadotrophin may cause ovarian hyperstimulation syndrome. The duration of stimulation and consumption of gonadotrophin appear to be longer and higher than in the early follicular phase start approach, although the number of retrieved/mature oocytes is comparable or, in some instances, higher. On the other hand, elevated progesterone concentrations during the luteal phase may prevent premature ovulation and, in theory, might replace pituitary suppression using gonadotrophin-releasing hormone antagonists or exogeneous progestins. Furthermore, the flexibility in stimulation timing will meet the needs of patients with time constraints.
{"title":"The good, the bad and the ugly of luteal phase stimulations","authors":"Barbara Lawrenz , Baris Ata , Human M. Fatemi","doi":"10.1016/j.rbmo.2024.104383","DOIUrl":"10.1016/j.rbmo.2024.104383","url":null,"abstract":"<div><div>An early follicular phase start of ovarian stimulation in assisted reproductive technology (ART) is only required if a fresh embryo transfer is planned. A shift from fresh to frozen embryo transfers has recently characterized ART treatments and, combined with the trend towards treatment individualization and simplification, facilitated random-start stimulation. Luteal phase stimulation, started between ovulation and the next menses, has gained momentum and the good, the bad and the ugly sides have become obvious with the increasing number performed. Unprotected intercourse during the follicular phase or around ovulation can result in an unknown and undetectable conception at the time of starting stimulation. Aside from the theoretical implications for embryo development from exposure to stimulation medication, embryo-derived human chorionic gonadotrophin may cause ovarian hyperstimulation syndrome. The duration of stimulation and consumption of gonadotrophin appear to be longer and higher than in the early follicular phase start approach, although the number of retrieved/mature oocytes is comparable or, in some instances, higher. On the other hand, elevated progesterone concentrations during the luteal phase may prevent premature ovulation and, in theory, might replace pituitary suppression using gonadotrophin-releasing hormone antagonists or exogeneous progestins. Furthermore, the flexibility in stimulation timing will meet the needs of patients with time constraints.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 6","pages":"Article 104383"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1016/j.rbmo.2024.104392
ZiHan Qin, QiaoHua Xiong, MingHan Lu, ShuHua Li, YuJun Chen, WenHan Ma, Ling Ma, Chun Zhou, Quanfei Zhu, YuanZhen Zhang, Ming Zhang, JunHao Lei
The aim of this meta-analysis was to quantify the available data concerning sperm retrieval rate (SRR) subsequent to testicular sperm extraction (TESE) and the clinical pregnancy rate (CPR) and live birth rate (LBR) subsequent to TESE and intracytoplasmic sperm injection (ICSI) in patients with non-obstructive azoospermia with cryptorchidism treated by orchidopexy. Furthermore, the aim was to explore the potential predictors of SRR, CPR and LBR within this population. Extensive searches were conducted in PubMed, Embase, Cochrane and Web of Science databases, and 23 articles were included in the study, with 1496 patients. The overall SRR per TESE cycle in the total evaluated trials was 60.9% (55.7-66.2%). Factors such as age at TESE, age at orchidopexy, testicular volume, and FSH, LH and testosterone levels did not affect final SRR. Meta-analyses were conducted on 13 studies each for CPR and LBR, including 913 and 799 ICSI cycles, respectively. The overall CPR per ICSI cycle was 37.6% (29.1-46.1%), and the overall LBR per ICSI cycle was 32.6% (24.9-40.4%). Factors as mentioned above, and the age of women undergoing ICSI, did not affect CPR or LBR per ICSI cycle. Although this meta-analysis extensively investigated outcomes of TESE and potential predictors of SRR, CPR and LBR for patients with non-obstructive azoospermia with cryptorchidism treated by orchidopexy, no effective predictors of outcomes were identified.
{"title":"Sperm recovery and ICSI outcomes in non-obstructive azoospermia with cryptorchidism treated by orchiopexy: a systematic review and meta-analysis.","authors":"ZiHan Qin, QiaoHua Xiong, MingHan Lu, ShuHua Li, YuJun Chen, WenHan Ma, Ling Ma, Chun Zhou, Quanfei Zhu, YuanZhen Zhang, Ming Zhang, JunHao Lei","doi":"10.1016/j.rbmo.2024.104392","DOIUrl":"https://doi.org/10.1016/j.rbmo.2024.104392","url":null,"abstract":"<p><p>The aim of this meta-analysis was to quantify the available data concerning sperm retrieval rate (SRR) subsequent to testicular sperm extraction (TESE) and the clinical pregnancy rate (CPR) and live birth rate (LBR) subsequent to TESE and intracytoplasmic sperm injection (ICSI) in patients with non-obstructive azoospermia with cryptorchidism treated by orchidopexy. Furthermore, the aim was to explore the potential predictors of SRR, CPR and LBR within this population. Extensive searches were conducted in PubMed, Embase, Cochrane and Web of Science databases, and 23 articles were included in the study, with 1496 patients. The overall SRR per TESE cycle in the total evaluated trials was 60.9% (55.7-66.2%). Factors such as age at TESE, age at orchidopexy, testicular volume, and FSH, LH and testosterone levels did not affect final SRR. Meta-analyses were conducted on 13 studies each for CPR and LBR, including 913 and 799 ICSI cycles, respectively. The overall CPR per ICSI cycle was 37.6% (29.1-46.1%), and the overall LBR per ICSI cycle was 32.6% (24.9-40.4%). Factors as mentioned above, and the age of women undergoing ICSI, did not affect CPR or LBR per ICSI cycle. Although this meta-analysis extensively investigated outcomes of TESE and potential predictors of SRR, CPR and LBR for patients with non-obstructive azoospermia with cryptorchidism treated by orchidopexy, no effective predictors of outcomes were identified.</p>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":" ","pages":"104392"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.1016/j.rbmo.2024.104393
Qiutong Li , Yi Dai , Xiaoyan Li , Yushi Wu , Zhiyue Gu , Chenyu Zhang , Hailan Yan , Shiqing Lyu , Biyun Zhang , Jinghua Shi , Jinhua Leng
Research question
Are there correlations between the biological expression of steroid receptors and the extent of fibrosis in adenomyotic lesions, and the treatment effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) on alleviation of adenomyosis-associated dysmenorrhoea.
Design
In this retrospective cohort study, 125 women with adenomyosis who underwent hysterectomy were screened. Tissue samples were collected from 41 patients who had undergone LNG-IUS treatment prior to surgery, and these patients were further categorized into the treatment effective group (n = 18) and the treatment failure group (n = 23) according to their self-reported relief from dysmenorrhoea after 6 months of treatment. Oestrogen receptor-α (ER-α) and progesterone receptor expression, and the extent of fibrosis in the adenomyotic lesions were measured using immunohistochemistry and Masson's trichrome staining, respectively.
Results
Patients in the treatment failure group demonstrated lower expression of ER-α and progesterone receptors, and more pronounced fibrosis in the stroma of adenomyotic lesions compared with patients in the treatment effective group. In the glandular epithelium of lesions, ER-α expression was reduced significantly in the treatment failure group, whereas no notable difference in the expression of progesterone receptors was observed. Notably, the staining intensity of ER-α in the stroma of lesions was found to have the strongest positive correlation with the degree of symptom alleviation for dysmenorrhoea (r = 0.703, P < 0.001), with an area under the curve of 0.894 for prediction.
Conclusions
The reduced expression of steroid receptors in adenomyotic lesions, especially ER-α in the stroma, was associated with increased likelihood of treatment failure of LNG-IUS for alleviation of dysmenorrhoea.
{"title":"Biological characteristics related to treatment effects of the levonorgestrel-releasing intrauterine system on adenomyosis-associated dysmenorrhoea","authors":"Qiutong Li , Yi Dai , Xiaoyan Li , Yushi Wu , Zhiyue Gu , Chenyu Zhang , Hailan Yan , Shiqing Lyu , Biyun Zhang , Jinghua Shi , Jinhua Leng","doi":"10.1016/j.rbmo.2024.104393","DOIUrl":"10.1016/j.rbmo.2024.104393","url":null,"abstract":"<div><h3>Research question</h3><div>Are there correlations between the biological expression of steroid receptors and the extent of fibrosis in adenomyotic lesions, and the treatment effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) on alleviation of adenomyosis-associated dysmenorrhoea.</div></div><div><h3>Design</h3><div>In this retrospective cohort study, 125 women with adenomyosis who underwent hysterectomy were screened. Tissue samples were collected from 41 patients who had undergone LNG-IUS treatment prior to surgery, and these patients were further categorized into the treatment effective group (<em>n</em> = 18) and the treatment failure group (<em>n</em> = 23) according to their self-reported relief from dysmenorrhoea after 6 months of treatment. Oestrogen receptor-α (ER-α) and progesterone receptor expression, and the extent of fibrosis in the adenomyotic lesions were measured using immunohistochemistry and Masson's trichrome staining, respectively.</div></div><div><h3>Results</h3><div>Patients in the treatment failure group demonstrated lower expression of ER-α and progesterone receptors, and more pronounced fibrosis in the stroma of adenomyotic lesions compared with patients in the treatment effective group. In the glandular epithelium of lesions, ER-α expression was reduced significantly in the treatment failure group, whereas no notable difference in the expression of progesterone receptors was observed. Notably, the staining intensity of ER-α in the stroma of lesions was found to have the strongest positive correlation with the degree of symptom alleviation for dysmenorrhoea (<em>r</em> = 0.703, <em>P</em> < 0.001), with an area under the curve of 0.894 for prediction.</div></div><div><h3>Conclusions</h3><div>The reduced expression of steroid receptors in adenomyotic lesions, especially ER-α in the stroma, was associated with increased likelihood of treatment failure of LNG-IUS for alleviation of dysmenorrhoea.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 6","pages":"Article 104393"},"PeriodicalIF":3.7,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Are there significant differences between cumulative live birth rates (CLBR) after short or extended embryo culture when comparisons are performed per cycle?
Design
This French national study included all IVF cycles performed from January 2016 to December 2019 with at least one cleaved embryo at day 2. The day 2/3 and day 5/6 groups were identified using the National Biomedicine Agency register. Only attempts involving the vitrification method were included. CLBR was assessed with 1 and 2 years of follow-up using a logistic regression model. The evolution of CLBR per cycle was compared over 1 year of follow-up.
Results
In total, 133,250 cycles met the inclusion criteria (70,528 and 62,722 in the day 2/3 and day 5/6 groups). In multivariate analysis including several patient and cycle characteristics, the CLBR per cycle was significantly lower in the day 5/6 compared with the day 2/3 group. A significantly higher rate of fresh embryo transfer cancellation was observed in the day 5/6 compared with the day 2/3 group. The evolution of the CLBR was significantly different in favour of the day 2/3 group in cases with three or fewer day 2 embryos, whatever the patient's age, in their two first attempts as well as in their third or further attempts.
Conclusions
Overall, the nationwide results per cycle suggest that extended embryo culture until the blastocyst stage, even when used in combination with vitrification, could not improve live birth rates. Moreover, where three or fewer day 2 embryos are obtained, it might be preferable to use the short embryo culture strategy.
{"title":"Comparisons of cumulative live birth rates after embryo transfers at day 2/3 versus day 5/6: a French national study","authors":"Patricia Fauque , Audrey Marchand Zebina , Sylvie Epelboin , Ana Rita Coutinho , Thomas Charbonnier , Imène Mansouri , Jessica Gane , Bastien Ducreux , Philippe Jonveaux , Fabrice Guérif","doi":"10.1016/j.rbmo.2024.104384","DOIUrl":"10.1016/j.rbmo.2024.104384","url":null,"abstract":"<div><h3>Research question</h3><div>Are there significant differences between cumulative live birth rates (CLBR) after short or extended embryo culture when comparisons are performed per cycle?</div></div><div><h3>Design</h3><div>This French national study included all IVF cycles performed from January 2016 to December 2019 with at least one cleaved embryo at day 2. The day 2/3 and day 5/6 groups were identified using the National Biomedicine Agency register. Only attempts involving the vitrification method were included. CLBR was assessed with 1 and 2 years of follow-up using a logistic regression model. The evolution of CLBR per cycle was compared over 1 year of follow-up.</div></div><div><h3>Results</h3><div>In total, 133,250 cycles met the inclusion criteria (70,528 and 62,722 in the day 2/3 and day 5/6 groups). In multivariate analysis including several patient and cycle characteristics, the CLBR per cycle was significantly lower in the day 5/6 compared with the day 2/3 group. A significantly higher rate of fresh embryo transfer cancellation was observed in the day 5/6 compared with the day 2/3 group. The evolution of the CLBR was significantly different in favour of the day 2/3 group in cases with three or fewer day 2 embryos, whatever the patient's age, in their two first attempts as well as in their third or further attempts.</div></div><div><h3>Conclusions</h3><div>Overall, the nationwide results per cycle suggest that extended embryo culture until the blastocyst stage, even when used in combination with vitrification, could not improve live birth rates. Moreover, where three or fewer day 2 embryos are obtained, it might be preferable to use the short embryo culture strategy.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 6","pages":"Article 104384"},"PeriodicalIF":3.7,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
What are the risk factors for a prolonged third stage of labour, closely related to postpartum haemorrhage, and what is the effect of assisted reproductive technology (ART) on the third stage of labour?
Design
Clinical data of women who delivered vaginally at term at 12 primary maternity hospitals in Japan (2010–2018) (n = 25,336) were obtained; 1148 (4.5%) conceived through ART and 2246 (8.9%) through non-ART treatments. The risk of a prolonged third stage of labour (defined as ≥20 min) was evaluated by univariable and multivariable regression analyses. Adjusted odds ratios (aOR) of a prolonged third stage of labour were evaluated, stratified by the type of ART, with natural conception as a reference.
Results
Multivariable analysis showed that pregnancy achieved through ART (aOR 4.38, 95% CI 3.12 to 6.15), history of spontaneous miscarriage (OR 1.40, 95% CI 1.06 to 1.84) and prolonged labour (OR 1.52, 95% CI 1.09 to 2.12) were identified as independent risk factors. Frozen embryo transfer (FET), FET in a hormone replacement cycle (HRC–FET) and blastocyst-stage embryo transfer were significantly associated with a prolonged third stage of labour (aOR 4.07, 95% CI 2.75 to 6.04, aOR 4.11, 95% CI 2.58 to 6.57 and aOR 2.13, 95% CI 1.15 to 3.95, respectively). No significant difference was observed in the duration of third stage of labour between natural conception and non-ART treatment (P = 0.61).
Conclusion
Pregnancy achieved through ART, particularly FET, HRC–FET and blastocyst-stage embryo transfer, was a significant risk factor for a prolonged third stage of labour.
研究问题与产后出血密切相关的第三产程延长的风险因素是什么，以及辅助生殖技术（ART）对第三产程的影响是什么？设计获得了在日本12家基层妇产医院经阴道分娩的足月产妇的临床数据（2010-2018年）（n = 25336）；其中1148人（4.5%）通过ART受孕，2246人（8.9%）通过非ART治疗受孕。通过单变量和多变量回归分析评估了第三产程延长（定义为≥20分钟）的风险。结果多变量分析显示，通过抗逆转录病毒疗法怀孕（aOR 4.38，95% CI 3.12-6.15）、自然流产史（OR 1.40，95% CI 1.06-1.84）和产程延长（OR 1.52，95% CI 1.09-2.12）被认为是独立的风险因素。冷冻胚胎移植（FET）、激素替代周期中的 FET（HRC-FET）和囊胚期胚胎移植与第三产程延长有显著相关性（分别为 aOR 4.07，95% CI 2.75 至 6.04；aOR 4.11，95% CI 2.58 至 6.57；aOR 2.13，95% CI 1.15 至 3.95）。结论通过抗逆转录病毒疗法（尤其是 FET、HRC-FET 和囊胚期胚胎移植）怀孕是导致第三产程延长的重要风险因素。
{"title":"Assisted reproductive technology and prolonged third stage of labour: a multicentre study in Japan","authors":"Akihito Kato , Takafumi Ushida , Seiko Matsuo , Sho Tano , Kenji Imai , Shigeru Yoshida , Mamoru Yamashita , Hiroaki Kajiyama , Tomomi Kotani","doi":"10.1016/j.rbmo.2024.104382","DOIUrl":"10.1016/j.rbmo.2024.104382","url":null,"abstract":"<div><h3>Research question</h3><div>What are the risk factors for a prolonged third stage of labour, closely related to postpartum haemorrhage, and what is the effect of assisted reproductive technology (ART) on the third stage of labour?</div></div><div><h3>Design</h3><div>Clinical data of women who delivered vaginally at term at 12 primary maternity hospitals in Japan (2010–2018) (<em>n</em> = 25,336) were obtained; 1148 (4.5%) conceived through ART and 2246 (8.9%) through non-ART treatments. The risk of a prolonged third stage of labour (defined as ≥20 min) was evaluated by univariable and multivariable regression analyses. Adjusted odds ratios (aOR) of a prolonged third stage of labour were evaluated, stratified by the type of ART, with natural conception as a reference.</div></div><div><h3>Results</h3><div>Multivariable analysis showed that pregnancy achieved through ART (aOR 4.38, 95% CI 3.12 to 6.15), history of spontaneous miscarriage (OR 1.40, 95% CI 1.06 to 1.84) and prolonged labour (OR 1.52, 95% CI 1.09 to 2.12) were identified as independent risk factors. Frozen embryo transfer (FET), FET in a hormone replacement cycle (HRC–FET) and blastocyst-stage embryo transfer were significantly associated with a prolonged third stage of labour (aOR 4.07, 95% CI 2.75 to 6.04, aOR 4.11, 95% CI 2.58 to 6.57 and aOR 2.13, 95% CI 1.15 to 3.95, respectively). No significant difference was observed in the duration of third stage of labour between natural conception and non-ART treatment (<em>P</em> = 0.61).</div></div><div><h3>Conclusion</h3><div>Pregnancy achieved through ART, particularly FET, HRC–FET and blastocyst-stage embryo transfer, was a significant risk factor for a prolonged third stage of labour.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 6","pages":"Article 104382"},"PeriodicalIF":3.7,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Direct and indirect evidence suggests that endometrial receptivity may play a crucial role in the reduced fertility rate of women with polycystic ovary syndrome (PCOS). Various pharmacological and non-pharmacological strategies with potential effects on endometrial receptivity in patients with PCOS have been proposed. The aim of this study was to summarize the rationale and the clinical and experimental evidence of interventions tested for improving endometrial receptivity in infertile patients with PCOS. A systematic review was conducted by consulting electronic databases. All interventions with a potential influence on endometrial receptivity in infertile patients with PCOS were evaluated, and their main biological mechanisms were analysed. In total, 24 interventions related to endometrial receptivity were identified. Notwithstanding a strong biological rationale, no intervention aimed at improving endometrial receptivity in women with PCOS is supported by an adequate body of evidence, limiting their use in clinical practice. Further high-quality research is needed in this field to limit potentially ineffective and unsafe add-on treatments in infertile patients with PCOS.
{"title":"Pharmacological and non-pharmacological interventions for improving endometrial receptivity in infertile patients with polycystic ovary syndrome: a comprehensive review of the available evidence","authors":"Stefano Palomba , Flavia Costanzi , Donatella Caserta , Amerigo Vitagliano","doi":"10.1016/j.rbmo.2024.104381","DOIUrl":"10.1016/j.rbmo.2024.104381","url":null,"abstract":"<div><div>Direct and indirect evidence suggests that endometrial receptivity may play a crucial role in the reduced fertility rate of women with polycystic ovary syndrome (PCOS). Various pharmacological and non-pharmacological strategies with potential effects on endometrial receptivity in patients with PCOS have been proposed. The aim of this study was to summarize the rationale and the clinical and experimental evidence of interventions tested for improving endometrial receptivity in infertile patients with PCOS. A systematic review was conducted by consulting electronic databases. All interventions with a potential influence on endometrial receptivity in infertile patients with PCOS were evaluated, and their main biological mechanisms were analysed. In total, 24 interventions related to endometrial receptivity were identified. Notwithstanding a strong biological rationale, no intervention aimed at improving endometrial receptivity in women with PCOS is supported by an adequate body of evidence, limiting their use in clinical practice. Further high-quality research is needed in this field to limit potentially ineffective and unsafe add-on treatments in infertile patients with PCOS.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 6","pages":"Article 104381"},"PeriodicalIF":3.7,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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