Attempts at assessing endometrial receptivity through its transcriptomic signature have unfortunately failed. On the contrary, RCTs have indicated that the period of receptivity is fairly wide, lasting 48–72 hours. Today, the ultimate challenge is to optimize hormonal preparation for frozen embryo transfers (FETs). Recent data have provided compelling evidence that vaginal progesterone provides insufficient plasma levels of progesterone in a large fraction of patients, which leads to lower live birth rates and increased risks of miscarriage. The most efficient option consists in delivering injectable progesterone, or opting for a combo approach associating vaginal and injectable progesterone.
{"title":"How Should We Assess the Endometrium of Infertile Patients? What Does the Future Look Like?","authors":"Sokteang Sean, Chloe Tran, Pichetra Ou, Chanpisey Ouk, Dominique de Ziegler","doi":"10.1142/s2661318223300039","DOIUrl":"https://doi.org/10.1142/s2661318223300039","url":null,"abstract":"Attempts at assessing endometrial receptivity through its transcriptomic signature have unfortunately failed. On the contrary, RCTs have indicated that the period of receptivity is fairly wide, lasting 48–72 hours. Today, the ultimate challenge is to optimize hormonal preparation for frozen embryo transfers (FETs). Recent data have provided compelling evidence that vaginal progesterone provides insufficient plasma levels of progesterone in a large fraction of patients, which leads to lower live birth rates and increased risks of miscarriage. The most efficient option consists in delivering injectable progesterone, or opting for a combo approach associating vaginal and injectable progesterone.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135349210","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 : 2023-09-01DOI: 10.1142/s2661318223500184
H. Latif Khan, C. Boothroyd, T. A. Chang, V. Novero, D. Y. L. Chan, C. H. Chen, M. K. Chung, K. Ezoe, S. Liow, K. Malhotra, K. Mantravadi, D. Morbeck, L. A. Tuan, P. Vichinsartvichai, R. Nisar, S. Sardar
{"title":"ASPIRE Guidelines for Assisted Reproductive Technology (ART) Laboratory Practice in Low and Medium Resource Settings","authors":"H. Latif Khan, C. Boothroyd, T. A. Chang, V. Novero, D. Y. L. Chan, C. H. Chen, M. K. Chung, K. Ezoe, S. Liow, K. Malhotra, K. Mantravadi, D. Morbeck, L. A. Tuan, P. Vichinsartvichai, R. Nisar, S. Sardar","doi":"10.1142/s2661318223500184","DOIUrl":"https://doi.org/10.1142/s2661318223500184","url":null,"abstract":"","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298242","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 : 2023-09-01DOI: 10.1142/s2661318223300040
Sokteang Sean, Chloe Tran, Pichetra Ou, Chanpisey Ouk, Jean Marc Ayoubi, Dominique de Ziegler
Assisted reproductive technologies (ART) have accomplished spectacular progresses over the last few years, leading to sustained implantation rates (sIR) [Formula: see text]60% following euploid blastocyst transfers. These results raise new challenges for infertility specialists, notably the ability to care for infertile couples who fail ART, sometimes recurrently. ART failures may be due to disorders residing in the endometrium (the soil) or embryo (seed). To simplify the review of this dilemma and limit variables, we focused our research on the outcome of euploid blastocysts transfers conducted in E2 and i.m. progesterone replacement cycles. This methodological choice for our research should not be confused with a therapeutic recommendation in case of ART failures. The sum of the data collected indicates that if recurrent implantation failure (RIF) exists, it is extremely rare, affecting only [Formula: see text]5% of ART couples.
{"title":"Assisted Reproductive Technologies (ART) Failures: Is It the Seed or the Soil?","authors":"Sokteang Sean, Chloe Tran, Pichetra Ou, Chanpisey Ouk, Jean Marc Ayoubi, Dominique de Ziegler","doi":"10.1142/s2661318223300040","DOIUrl":"https://doi.org/10.1142/s2661318223300040","url":null,"abstract":"Assisted reproductive technologies (ART) have accomplished spectacular progresses over the last few years, leading to sustained implantation rates (sIR) [Formula: see text]60% following euploid blastocyst transfers. These results raise new challenges for infertility specialists, notably the ability to care for infertile couples who fail ART, sometimes recurrently. ART failures may be due to disorders residing in the endometrium (the soil) or embryo (seed). To simplify the review of this dilemma and limit variables, we focused our research on the outcome of euploid blastocysts transfers conducted in E2 and i.m. progesterone replacement cycles. This methodological choice for our research should not be confused with a therapeutic recommendation in case of ART failures. The sum of the data collected indicates that if recurrent implantation failure (RIF) exists, it is extremely rare, affecting only [Formula: see text]5% of ART couples.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298009","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 : 2021-12-01DOI: 10.1142/s2661318221500195
G. Lash
Decidual leukocytes make up approximately 30% of all decidual stromal cells in early pregnancy, of which 70% are uterine natural killer (uNK) cells. uNK cells are phenotypically distinct from peripheral blood NK cells, being CD56[Formula: see text]CD16[Formula: see text]. A recent single-cell sequencing project of the decidua identified three subsets of uNK cells, but we are yet to determine how they differ functionally. Several roles for uNK cells in implantation are starting to emerge including biosensing of poor-quality embryos, killing of bacteria infected trophoblast, spiral artery remodeling, and regulation of trophoblast invasion. Altered numbers of uNK cells have been identified in several pathological conditions, but whether this is causative of the condition is currently unclear.
{"title":"Uterine Natural Killer Cells and Implantation","authors":"G. Lash","doi":"10.1142/s2661318221500195","DOIUrl":"https://doi.org/10.1142/s2661318221500195","url":null,"abstract":"Decidual leukocytes make up approximately 30% of all decidual stromal cells in early pregnancy, of which 70% are uterine natural killer (uNK) cells. uNK cells are phenotypically distinct from peripheral blood NK cells, being CD56[Formula: see text]CD16[Formula: see text]. A recent single-cell sequencing project of the decidua identified three subsets of uNK cells, but we are yet to determine how they differ functionally. Several roles for uNK cells in implantation are starting to emerge including biosensing of poor-quality embryos, killing of bacteria infected trophoblast, spiral artery remodeling, and regulation of trophoblast invasion. Altered numbers of uNK cells have been identified in several pathological conditions, but whether this is causative of the condition is currently unclear.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77201825","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 : 2021-12-01DOI: 10.1142/s2661318221500201
A. Tanaka, M. Nagayoshi, Yasuho Yanagihara, I. Tanaka, T. Akahoshi, Megumi Araki, Nao Urabe, Akihiro Tanaka, Tatsuya Sato
Background: It is controversial whether that “Freeze-only” strategy is superior to Fresh embryo transfer in ART patients with normal ovarian response. There are two reasons supporting a “Freeze-only” strategy. One is that frozen-thawed embryos are transferred to a more physiologically receptive endometrium. While fresh embryos are transferred to a badly affected one because of controlled-ovarian stimulations, which cause the discordant development of the endometrium, when thawed-frozen embryos are transferred in a subsequent cycle the endometrium is not affected by high estrogen levels. The other reason is the big difference in cryopreservation and stimulation techniques. Methods: We investigated the annual ART reports in Japan from 1992 to 2018, and our clinical outcomes of frozen-thawed embryo transfers and fresh embryo transfers from 2015 to 2019. This enabled the assessment of the survival rate of frozen blastocyst by Cryotop safety kit after thawing in four different clinics. We compared the outcomes of frozen embryo transfer (FroET) to fresh embryo transfer. Results: The proportion of birth in Japan in the study interval found that FroET was responsible for 86.7% of births, compared to 13.3% of births resulting from fresh embryo transfers after IVF or intracytoplasmic sperm injection (ICSI). Clinical outcome of FroET in our clinic was significantly higher than that of fresh embryo transfer regardless of maternal age and number of collected oocytes. Average survival rate of frozen blastocyst by Cryotop safety kit after thawing in four clinics was over 95%. Conclusions: We believe that “Freeze-only high-quality blastocysts” is superior to fresh embryo transfer in terms of clinical outcome, at least when compared to historical results.
{"title":"Wisdom of Freezing All Valuable Embryos","authors":"A. Tanaka, M. Nagayoshi, Yasuho Yanagihara, I. Tanaka, T. Akahoshi, Megumi Araki, Nao Urabe, Akihiro Tanaka, Tatsuya Sato","doi":"10.1142/s2661318221500201","DOIUrl":"https://doi.org/10.1142/s2661318221500201","url":null,"abstract":"Background: It is controversial whether that “Freeze-only” strategy is superior to Fresh embryo transfer in ART patients with normal ovarian response. There are two reasons supporting a “Freeze-only” strategy. One is that frozen-thawed embryos are transferred to a more physiologically receptive endometrium. While fresh embryos are transferred to a badly affected one because of controlled-ovarian stimulations, which cause the discordant development of the endometrium, when thawed-frozen embryos are transferred in a subsequent cycle the endometrium is not affected by high estrogen levels. The other reason is the big difference in cryopreservation and stimulation techniques. Methods: We investigated the annual ART reports in Japan from 1992 to 2018, and our clinical outcomes of frozen-thawed embryo transfers and fresh embryo transfers from 2015 to 2019. This enabled the assessment of the survival rate of frozen blastocyst by Cryotop safety kit after thawing in four different clinics. We compared the outcomes of frozen embryo transfer (FroET) to fresh embryo transfer. Results: The proportion of birth in Japan in the study interval found that FroET was responsible for 86.7% of births, compared to 13.3% of births resulting from fresh embryo transfers after IVF or intracytoplasmic sperm injection (ICSI). Clinical outcome of FroET in our clinic was significantly higher than that of fresh embryo transfer regardless of maternal age and number of collected oocytes. Average survival rate of frozen blastocyst by Cryotop safety kit after thawing in four clinics was over 95%. Conclusions: We believe that “Freeze-only high-quality blastocysts” is superior to fresh embryo transfer in terms of clinical outcome, at least when compared to historical results.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78173657","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 : 2021-11-15DOI: 10.1142/s2661318221500158
Yun-Chiao Hsieh, P. Yang, Mei-Jou Chen
Polycystic ovary syndrome (PCOS) is a common endocrinopathy in women of reproductive age. Although its essential clinical manifestation includes a plethora of symptoms and signs, which largely reflects the underlying hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology, PCOS may also be associated with many metabolic derangements. These metabolic derangements happen to overlap with many of the core constituents of the metabolic syndrome (MBS)—increased insulin resistance, central obesity, and dyslipidemia. The two disorders also display similarly increased risks for certain metabolic and vascular diseases, such as type 2 diabetes mellitus, hypertension, and cardiovascular diseases. Due to the many similarities between metabolic syndrome and PCOS, this review aims to examine the evidence concerning the overlapping features, the risks for comorbidities, possible shared mechanisms, and treatment strategies in patients with coexisting PCOS and MBS.
{"title":"Metabolic Syndrome in Polycystic Ovary Syndrome","authors":"Yun-Chiao Hsieh, P. Yang, Mei-Jou Chen","doi":"10.1142/s2661318221500158","DOIUrl":"https://doi.org/10.1142/s2661318221500158","url":null,"abstract":"Polycystic ovary syndrome (PCOS) is a common endocrinopathy in women of reproductive age. Although its essential clinical manifestation includes a plethora of symptoms and signs, which largely reflects the underlying hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology, PCOS may also be associated with many metabolic derangements. These metabolic derangements happen to overlap with many of the core constituents of the metabolic syndrome (MBS)—increased insulin resistance, central obesity, and dyslipidemia. The two disorders also display similarly increased risks for certain metabolic and vascular diseases, such as type 2 diabetes mellitus, hypertension, and cardiovascular diseases. Due to the many similarities between metabolic syndrome and PCOS, this review aims to examine the evidence concerning the overlapping features, the risks for comorbidities, possible shared mechanisms, and treatment strategies in patients with coexisting PCOS and MBS.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86309361","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 : 2021-10-27DOI: 10.1142/s266131822150016x
Dung P. Nguyen, Q. T. Pham, Thanh L. Tran, L. Vuong, T. Ho
Background:Embryo selection plays an important role in the success of in vitro fertilization (IVF). However, morphological embryo assessment has a number of limitations, including the time required, lack of accuracy, and inconsistency. This study determined whether a machine learning-based model could predict blastocyst formation using day-3 embryo images. Methods:Day-3 embryo images from IVF/intracytoplasmic sperm injection (ICSI) cycles performed at My Duc Phu Nhuan Hospital between August 2018 and June 2019 were retrospectively analyzed to inform model development. Day-3 embryo images derived from two-pronuclear (2PN) zygotes with known blastocyst formation data were extracted from the CCM-iBIS time-lapse incubator (Astec, Japan) at 67 hours post ICSI, and labeled as blastocyst/non-blastocyst based on results at 116 hours post ICSI. Images were used as the input dataset to train (85%) and validate (15%) the convolutional neural network (CNN) model, then model accuracy was determined using the training and validation dataset. The performance of 13 experienced embryologists for predicting blastocyst formation based on 100 day-3 embryo images was also evaluated. Results:A total of 1,135 images were allocated into training ([Formula: see text] = 967) and validation ([Formula: see text] = 168) sets, with an even distribution for blastocyst formation outcome. The accuracy of the final model for blastocyst formation was 97.72% in the training dataset and 76.19% in the validation dataset. The final model predicted blastocyst formation from day-3 embryo images in the validation dataset with an area under the curve of 0.75 (95% confidence interval [CI] 0.69–0.81). Embryologists predicted blastocyst formation with the accuracy of 70.07% (95% CI 68.12%–72.03%), sensitivity of 87.04% (95% CI 82.56%–91.52%), and specificity of 30.93% (95% CI 29.35%–32.51%). Conclusions:The CNN-based machine learning model using day-3 embryo images predicted blastocyst formation more accurately than experienced embryologists. The CNN-based model is a potential tool to predict additional IVF outcomes.
背景:胚胎选择对体外受精(IVF)的成功起着重要作用。然而，形态学胚胎评估有许多局限性，包括所需的时间，缺乏准确性和不一致。这项研究确定了基于机器学习的模型是否可以使用第3天的胚胎图像预测囊胚形成。方法:回顾性分析2018年8月至2019年6月在美德府南医院进行的IVF/胞浆内单精子注射(ICSI)周期的第3天胚胎图像，为模型开发提供信息。在ICSI后67小时，从CCM-iBIS定时培养箱(Astec，日本)中提取具有已知囊胚形成数据的双原核(2PN)受精卵的第3天胚胎图像，并根据ICSI后116小时的结果标记为囊胚/非囊胚。使用图像作为输入数据集对卷积神经网络(CNN)模型进行训练(85%)和验证(15%)，然后使用训练和验证数据集确定模型的精度。13名经验丰富的胚胎学家根据100天的胚胎图像预测囊胚形成的表现也进行了评估。结果:共有1135张图像被分配到训练集([公式:见文]= 967)和验证集([公式:见文]= 168)，囊胚形成结果分布均匀。最终的囊胚形成模型在训练数据集中的准确率为97.72%，在验证数据集中的准确率为76.19%。最终模型根据验证数据集中第3天的胚胎图像预测囊胚形成，曲线下面积为0.75(95%置信区间[CI] 0.69-0.81)。胚胎学家预测囊胚形成的准确率为70.07% (95% CI 68.12% ~ 72.03%)，敏感性为87.04% (95% CI 82.56% ~ 91.52%)，特异性为30.93% (95% CI 29.35% ~ 32.51%)。结论:使用第3天胚胎图像的基于cnn的机器学习模型比经验丰富的胚胎学家更准确地预测囊胚形成。基于cnn的模型是预测其他试管婴儿结果的潜在工具。
{"title":"Blastocyst Prediction of Day-3 Cleavage-Stage Embryos Using Machine Learning","authors":"Dung P. Nguyen, Q. T. Pham, Thanh L. Tran, L. Vuong, T. Ho","doi":"10.1142/s266131822150016x","DOIUrl":"https://doi.org/10.1142/s266131822150016x","url":null,"abstract":"Background:Embryo selection plays an important role in the success of in vitro fertilization (IVF). However, morphological embryo assessment has a number of limitations, including the time required, lack of accuracy, and inconsistency. This study determined whether a machine learning-based model could predict blastocyst formation using day-3 embryo images. Methods:Day-3 embryo images from IVF/intracytoplasmic sperm injection (ICSI) cycles performed at My Duc Phu Nhuan Hospital between August 2018 and June 2019 were retrospectively analyzed to inform model development. Day-3 embryo images derived from two-pronuclear (2PN) zygotes with known blastocyst formation data were extracted from the CCM-iBIS time-lapse incubator (Astec, Japan) at 67 hours post ICSI, and labeled as blastocyst/non-blastocyst based on results at 116 hours post ICSI. Images were used as the input dataset to train (85%) and validate (15%) the convolutional neural network (CNN) model, then model accuracy was determined using the training and validation dataset. The performance of 13 experienced embryologists for predicting blastocyst formation based on 100 day-3 embryo images was also evaluated. Results:A total of 1,135 images were allocated into training ([Formula: see text] = 967) and validation ([Formula: see text] = 168) sets, with an even distribution for blastocyst formation outcome. The accuracy of the final model for blastocyst formation was 97.72% in the training dataset and 76.19% in the validation dataset. The final model predicted blastocyst formation from day-3 embryo images in the validation dataset with an area under the curve of 0.75 (95% confidence interval [CI] 0.69–0.81). Embryologists predicted blastocyst formation with the accuracy of 70.07% (95% CI 68.12%–72.03%), sensitivity of 87.04% (95% CI 82.56%–91.52%), and specificity of 30.93% (95% CI 29.35%–32.51%). Conclusions:The CNN-based machine learning model using day-3 embryo images predicted blastocyst formation more accurately than experienced embryologists. The CNN-based model is a potential tool to predict additional IVF outcomes.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78464989","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 : 2021-09-01DOI: 10.1142/s2661318221500110
Eileen M. Manalo, Ina S. Irabon, Shayne S. Fajutagana
Background: Despite the lack of approved testosterone formulations for women in most countries, testosterone therapy is still being offered to women worldwide. Aging and loss of ovarian or adrenal function, among others, can lower testosterone levels in women. However, international guidelines currently do not routinely recommend androgen replacement therapy due to lack of long-term safety data. Evidence on its benefits and risks still remains uncertain. Objectives: The aim of this literature review is to present current studies and guidelines that examined the effects of testosterone therapy for postmenopausal women, including its role on cognition and mood; breast and endometrial cancer risks; musculoskeletal, cardiovascular, and genitourinary health; and sexual function. Methodology: A review of literature was done using PubMed, EMBASE, Science Direct, OVID, and Google scholar, with the following key words: androgen, testosterone, menopause, and hypoactive sexual desire dysfunction. We identified reviews, clinical trials, and guidelines. The population was limited to postmenopausal women. Results: There is no evidence from current published literature to support the use of testosterone therapy for female well-being, mood and cognition, bone and cardiovascular health. Intravaginal testosterone appears to be a promising alternative for the treatment of genitourinary symptoms of menopause (GSM) but efficacy and safety are yet to be confirmed. Well-designed, randomized, and placebo-controlled trials are needed to establish long-term safety, efficacy, and appropriate dosing and route of testosterone therapy in postmenopausal women. The only evidence-based indication for testosterone therapy in women is for the treatment of postmenopausal hypoactive sexual desire disorder (HSDD). Should a trial of testosterone therapy be given for HSDD, the transdermal route is the preferred method of delivery. Baseline total testosterone concentration should be determined before starting treatment, and repeated after 3–6 months. Serum testosterone levels should be monitored at regular intervals to avoid supraphysiologic dosing. Conclusion: Currently, there is no robust evidence to support the use of exogenous testosterone to improve female well-being, musculoskeletal health, mood and cognition, as well as bone and cardiovascular health among postmenopausal women. The only evidence-based indication for testosterone therapy in women is the treatment of postmenopausal hypoactive sexual desire disorder, but only after all other causes of sexual dysfunction have been ruled out. To date, testosterone therapy has no US Food and Drug Administration (US FDA) approval due to the lack of long-term efficacy and safety data.
{"title":"The Role of Testosterone in Menopause Management: A Review of Literature","authors":"Eileen M. Manalo, Ina S. Irabon, Shayne S. Fajutagana","doi":"10.1142/s2661318221500110","DOIUrl":"https://doi.org/10.1142/s2661318221500110","url":null,"abstract":"Background: Despite the lack of approved testosterone formulations for women in most countries, testosterone therapy is still being offered to women worldwide. Aging and loss of ovarian or adrenal function, among others, can lower testosterone levels in women. However, international guidelines currently do not routinely recommend androgen replacement therapy due to lack of long-term safety data. Evidence on its benefits and risks still remains uncertain. Objectives: The aim of this literature review is to present current studies and guidelines that examined the effects of testosterone therapy for postmenopausal women, including its role on cognition and mood; breast and endometrial cancer risks; musculoskeletal, cardiovascular, and genitourinary health; and sexual function. Methodology: A review of literature was done using PubMed, EMBASE, Science Direct, OVID, and Google scholar, with the following key words: androgen, testosterone, menopause, and hypoactive sexual desire dysfunction. We identified reviews, clinical trials, and guidelines. The population was limited to postmenopausal women. Results: There is no evidence from current published literature to support the use of testosterone therapy for female well-being, mood and cognition, bone and cardiovascular health. Intravaginal testosterone appears to be a promising alternative for the treatment of genitourinary symptoms of menopause (GSM) but efficacy and safety are yet to be confirmed. Well-designed, randomized, and placebo-controlled trials are needed to establish long-term safety, efficacy, and appropriate dosing and route of testosterone therapy in postmenopausal women. The only evidence-based indication for testosterone therapy in women is for the treatment of postmenopausal hypoactive sexual desire disorder (HSDD). Should a trial of testosterone therapy be given for HSDD, the transdermal route is the preferred method of delivery. Baseline total testosterone concentration should be determined before starting treatment, and repeated after 3–6 months. Serum testosterone levels should be monitored at regular intervals to avoid supraphysiologic dosing. Conclusion: Currently, there is no robust evidence to support the use of exogenous testosterone to improve female well-being, musculoskeletal health, mood and cognition, as well as bone and cardiovascular health among postmenopausal women. The only evidence-based indication for testosterone therapy in women is the treatment of postmenopausal hypoactive sexual desire disorder, but only after all other causes of sexual dysfunction have been ruled out. To date, testosterone therapy has no US Food and Drug Administration (US FDA) approval due to the lack of long-term efficacy and safety data.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75540141","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 : 2021-09-01DOI: 10.1142/s2661318221500146
A. Shyamsunder, T. Hardy, A. Yazdani, A. Polyakov, R. Norman, R. Hart, F. Agresta, L. Rombauts, C. Boothroyd, M. Chapman, Prudence Sweeten, Eleanor Somerville, Rachel Jose, H. Wand, W. Ledger
Research Question: Does the dose of gonadotropin used for superovulation in IVF affect the proportion of euploid blastocysts obtained after fertilization? Study Design: Multicentre randomized controlled trial recruiting 57 women who were treated with ovarian stimulation using either 150 or 300 IU Menopur per day. Both groups received GnRH antagonist from day 5 of ovarian stimulation and final oocyte maturation was induced using a leuprolide GnRH (gonadotropin releasing hormone) agonist trigger when three or more follicles reached 17 mm diameter. Oocyte collection was scheduled 36–38 hours post trigger. In vitro fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) were performed according to individual unit protocol and embryos were cultured to blastocyst stage. A trophectoderm biopsy was performed on day 5 of embryo culture and used for preimplantation genetic testing for aneuploidy. Euploid embryos were transferred in subsequent frozen embryo transfer cycles with appropriate endometrial preparation. Results: The number of oocytes obtained from women randomized to 150 IU Menopur was between 3 and 17 (mean = 9), whereas the number of oocytes obtained from women randomized to 300 IU Menopur was between 3 and 24 (mean = 11). There was a positive linear relationship between serum AMH concentration and oocyte yield in both the 150 and 300 IU Menopur groups ([Formula: see text] = 0.3359, [Formula: see text] = 0.1129 and [Formula: see text] = 0.3741, [Formula: see text] = 0.1399). The percentage of euploid to aneuploid embryos in the 150 IU Menopur group was 63% and in the 300 IU Menopur group, the proportion was 75%, which was not significantly different ([Formula: see text] = 0.17). Conclusion: The higher dose ovarian stimulation protocol did not significantly increase the number of oocytes retrieved, nor did the higher dose protocol reduce the proportion of euploid embryos created. This study does not support the hypothesis that use of higher doses of gonadotropin for ovarian stimulation results in a reduction in the proportion of euploid embryos obtained after IVF.
{"title":"Higher Doses of FSH Used for Superovulation Do Not Adversely Affect Embryonic Ploidy: A Randomized Controlled Trial (STimulation Resulting in Embryonic Aneuploidy using Menopur (STREAM) Trial)","authors":"A. Shyamsunder, T. Hardy, A. Yazdani, A. Polyakov, R. Norman, R. Hart, F. Agresta, L. Rombauts, C. Boothroyd, M. Chapman, Prudence Sweeten, Eleanor Somerville, Rachel Jose, H. Wand, W. Ledger","doi":"10.1142/s2661318221500146","DOIUrl":"https://doi.org/10.1142/s2661318221500146","url":null,"abstract":"Research Question: Does the dose of gonadotropin used for superovulation in IVF affect the proportion of euploid blastocysts obtained after fertilization? Study Design: Multicentre randomized controlled trial recruiting 57 women who were treated with ovarian stimulation using either 150 or 300 IU Menopur per day. Both groups received GnRH antagonist from day 5 of ovarian stimulation and final oocyte maturation was induced using a leuprolide GnRH (gonadotropin releasing hormone) agonist trigger when three or more follicles reached 17 mm diameter. Oocyte collection was scheduled 36–38 hours post trigger. In vitro fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) were performed according to individual unit protocol and embryos were cultured to blastocyst stage. A trophectoderm biopsy was performed on day 5 of embryo culture and used for preimplantation genetic testing for aneuploidy. Euploid embryos were transferred in subsequent frozen embryo transfer cycles with appropriate endometrial preparation. Results: The number of oocytes obtained from women randomized to 150 IU Menopur was between 3 and 17 (mean = 9), whereas the number of oocytes obtained from women randomized to 300 IU Menopur was between 3 and 24 (mean = 11). There was a positive linear relationship between serum AMH concentration and oocyte yield in both the 150 and 300 IU Menopur groups ([Formula: see text] = 0.3359, [Formula: see text] = 0.1129 and [Formula: see text] = 0.3741, [Formula: see text] = 0.1399). The percentage of euploid to aneuploid embryos in the 150 IU Menopur group was 63% and in the 300 IU Menopur group, the proportion was 75%, which was not significantly different ([Formula: see text] = 0.17). Conclusion: The higher dose ovarian stimulation protocol did not significantly increase the number of oocytes retrieved, nor did the higher dose protocol reduce the proportion of euploid embryos created. This study does not support the hypothesis that use of higher doses of gonadotropin for ovarian stimulation results in a reduction in the proportion of euploid embryos obtained after IVF.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88514633","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 : 2021-09-01DOI: 10.1142/s2661318221500109
J. Banu, Mumtahena Amir, Shakeela Ishrat, Sadia Afrin Munmun, N. Sultana
Anomalies of the reproductive tract are common and present in about 3%–5% of the general population and in about 3% of infertile women. In general, they are asymptomatic, but they can also be associated with recurrent abortions or infertility. This is the case of a 27-year-old nulliparous woman presenting with the history of seven consecutive first trimester spontaneous abortions. Since her marriage 10 years back she conceived on repeated times but all the pregnancies ended in spontaneous miscarriage at around 10–12 weeks. Hysterosalpingography revealed a bicornuate/septate uterus. Hysteroscopic septoplasty with concurrent laparoscopy was planned after normalization of the endocrine parameters. She conceived spontaneously 7 months after the surgery. She had luteal phase support with progesterone, cervical cerclage and management of gestational diabetes, and pregnancy-induced hypertension. At 37 weeks of gestation, elective caesarean section was done with the delivery of a healthy female baby.
{"title":"Successful Outcome Following Hysteroscopic Septoplasty in a Woman with Seven Consecutive Pregnancy Losses","authors":"J. Banu, Mumtahena Amir, Shakeela Ishrat, Sadia Afrin Munmun, N. Sultana","doi":"10.1142/s2661318221500109","DOIUrl":"https://doi.org/10.1142/s2661318221500109","url":null,"abstract":"Anomalies of the reproductive tract are common and present in about 3%–5% of the general population and in about 3% of infertile women. In general, they are asymptomatic, but they can also be associated with recurrent abortions or infertility. This is the case of a 27-year-old nulliparous woman presenting with the history of seven consecutive first trimester spontaneous abortions. Since her marriage 10 years back she conceived on repeated times but all the pregnancies ended in spontaneous miscarriage at around 10–12 weeks. Hysterosalpingography revealed a bicornuate/septate uterus. Hysteroscopic septoplasty with concurrent laparoscopy was planned after normalization of the endocrine parameters. She conceived spontaneously 7 months after the surgery. She had luteal phase support with progesterone, cervical cerclage and management of gestational diabetes, and pregnancy-induced hypertension. At 37 weeks of gestation, elective caesarean section was done with the delivery of a healthy female baby.","PeriodicalId":34382,"journal":{"name":"Fertility Reproduction","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77983461","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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