Assisted reproductive technology (ART) is a commonly used treatment for infertile couples. However, the suboptimal success rate of ART highlights the urgent need for optimization. One promising strategy to significantly improve ART outcomes is to standardize and automate all steps involved, ranging from high-quality gamete selection to in vitro fertilization, embryo culture, embryo examination, and selection as well as gamete and embryo cryopreservation. Cutting-edge technologies, such as microfluidics and artificial intelligence (AI), have been developed for this purpose and have demonstrated remarkable potential in this area. Microfluidic systems have the potential to integrate ART steps into a miniaturized and automated device, which can minimize human error, save time and costs, enhance reproducibility and consistency, and improve accuracy. Additionally, AI is playing an increasingly important role in automating key aspects of ART. Leveraging its powerful abilities in rapid, accurate, and intelligent analysis of large biomedical datasets, AI assists doctors and embryologists in making more informed and effective decisions. In summary, these bioengineering technologies have the potential to revolutionize ART, making it faster, more efficient, and ultimately more effective for couples seeking to conceive. This article provides a comprehensive overview of how microfluidics and AI are being applied in ART to advance the field and benefit patients.
辅助生殖技术（ART）是治疗不孕不育夫妇的常用方法。然而，辅助生殖技术的成功率并不理想，这凸显了优化的迫切需要。大幅提高 ART 治疗效果的一个可行策略是实现从优质配子选择到体外受精、胚胎培养、胚胎检查和选择以及配子和胚胎冷冻保存等所有相关步骤的标准化和自动化。微流控技术和人工智能（AI）等尖端技术就是为此而开发的，并在这一领域展现出了巨大的潜力。微流控系统有可能将 ART 步骤整合到一个微型自动化设备中，从而最大限度地减少人为错误，节约时间和成本，提高可重复性和一致性，并提高准确性。此外，人工智能在 ART 关键环节的自动化方面发挥着越来越重要的作用。人工智能利用其快速、准确和智能分析大型生物医学数据集的强大能力，协助医生和胚胎学家做出更明智、更有效的决定。总之，这些生物工程技术有可能彻底改变人工生殖技术，使其更快、更高效，并最终为寻求怀孕的夫妇带来更大的效益。本文全面概述了微流控技术和人工智能如何应用于 ART，以推动该领域的发展并造福患者。
{"title":"Bioengineering: a promising approach for standardization and automation of assisted reproductive technology","authors":"Fatemeh Amjad M.Sc. , Mohammad Amin Hajari M.Sc. , Azam Dalman Ph.D. , Hossein Baharvand Ph.D. , Leila Montazeri Ph.D.","doi":"10.1016/j.xfnr.2024.01.002","DOIUrl":"10.1016/j.xfnr.2024.01.002","url":null,"abstract":"<div><p>Assisted reproductive technology (ART) is a commonly used treatment for infertile couples. However, the suboptimal success rate of ART highlights the urgent need for optimization. One promising strategy to significantly improve ART outcomes is to standardize and automate all steps involved, ranging from high-quality gamete selection to in vitro fertilization, embryo culture, embryo examination, and selection as well as gamete and embryo cryopreservation. Cutting-edge technologies, such as microfluidics and artificial intelligence (AI), have been developed for this purpose and have demonstrated remarkable potential in this area. Microfluidic systems have the potential to integrate ART steps into a miniaturized and automated device, which can minimize human error, save time and costs, enhance reproducibility and consistency, and improve accuracy. Additionally, AI is playing an increasingly important role in automating key aspects of ART. Leveraging its powerful abilities in rapid, accurate, and intelligent analysis of large biomedical datasets, AI assists doctors and embryologists in making more informed and effective decisions. In summary, these bioengineering technologies have the potential to revolutionize ART, making it faster, more efficient, and ultimately more effective for couples seeking to conceive. This article provides a comprehensive overview of how microfluidics and AI are being applied in ART to advance the field and benefit patients.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139637019","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 : 2024-01-01DOI: 10.1016/j.xfnr.2023.11.001
Jennifer J. Yland Ph.D. , Lauren A. Wise Sc.D.
{"title":"The adverse effects of commonly used medications on male fertility: letter to the editor","authors":"Jennifer J. Yland Ph.D. , Lauren A. Wise Sc.D.","doi":"10.1016/j.xfnr.2023.11.001","DOIUrl":"10.1016/j.xfnr.2023.11.001","url":null,"abstract":"","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138612111","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 : 2023-10-01DOI: 10.1016/j.xfnr.2023.10.001
Elizabeth Manguso B.S., B.A. , Elizabeth G. Thayer M.D. , Kristen D. Starbuck M.D. , Audrey Marsidi M.D.
Objective
To review the literature on the fertility outcomes for individuals using assisted reproductive technologies (ARTs) after fertility-sparing treatment (FST) for endometrial neoplasia. Answering this question has the potential to influence clinical practice, improve patient counseling, and guide further research.
Evidence Review
Inclusion criteria were as follows: prospective and retrospective studies evaluating patients with complex atypical hyperplasia, endometrial intraepithelial neoplasia (EIN), or endometrial adenocarcinoma (EAC) who underwent FST, have a group or subgroup of patients who used ART, and discuss pregnancy-related outcomes for the ART cycles or proportion of patients using ART methods. Articles not in English were excluded. Four independent reviewers reviewed articles for inclusion. Twenty-five articles met the inclusion criteria, including 19 retrospective studies, 5 prospective studies, and 1 randomized control trial.
Results
Assisted reproductive technology utilization among this population is high; although live birth rate per transfer is lower than expected, cumulative pregnancy rates approach what may be expected in other groups. Factors associated with success with in vitro fertilization (IVF) may include endometrial thickness >8 mm and shorter time to treatment after complete remission. Additionally, IVF does not increase mortality from EIN/EAC.
Conclusion
Overall, this review demonstrated that ART can be an effective treatment option for individuals desiring fertility after FST for EIN/EAC; however, additional research is needed into pregnancy outcomes with ART methods after FST and the timing of treatment initiation. Providers should be diligent in referring individuals who desire pregnancy after FST to reproductive endocrinology and infertility services to increase the chances of pregnancy before disease recurrence.
{"title":"Fertility outcomes with assisted reproductive technology after fertility-sparing treatment for endometrial neoplasia: a systematic review","authors":"Elizabeth Manguso B.S., B.A. , Elizabeth G. Thayer M.D. , Kristen D. Starbuck M.D. , Audrey Marsidi M.D.","doi":"10.1016/j.xfnr.2023.10.001","DOIUrl":"10.1016/j.xfnr.2023.10.001","url":null,"abstract":"<div><h3>Objective</h3><p>To review the literature on the fertility outcomes for individuals using assisted reproductive technologies<span> (ARTs) after fertility-sparing treatment (FST) for endometrial neoplasia. Answering this question has the potential to influence clinical practice, improve patient counseling, and guide further research.</span></p></div><div><h3>Evidence Review</h3><p>Inclusion criteria were as follows: prospective and retrospective studies evaluating patients with complex atypical hyperplasia<span><span>, endometrial intraepithelial neoplasia (EIN), or </span>endometrial adenocarcinoma<span> (EAC) who underwent FST, have a group or subgroup of patients who used ART, and discuss pregnancy-related outcomes for the ART cycles or proportion of patients using ART methods. Articles not in English were excluded. Four independent reviewers reviewed articles for inclusion. Twenty-five articles met the inclusion criteria, including 19 retrospective studies, 5 prospective studies, and 1 randomized control trial.</span></span></p></div><div><h3>Results</h3><p>Assisted reproductive technology utilization among this population is high; although live birth rate per transfer is lower than expected, cumulative pregnancy rates approach what may be expected in other groups. Factors associated with success with in vitro fertilization (IVF) may include endometrial thickness >8 mm and shorter time to treatment after complete remission. Additionally, IVF does not increase mortality from EIN/EAC.</p></div><div><h3>Conclusion</h3><p>Overall, this review demonstrated that ART can be an effective treatment option for individuals desiring fertility after FST for EIN/EAC; however, additional research is needed into pregnancy outcomes with ART methods after FST and the timing of treatment initiation. Providers should be diligent in referring individuals who desire pregnancy after FST to reproductive endocrinology and infertility services to increase the chances of pregnancy before disease recurrence.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136128568","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 : 2023-10-01DOI: 10.1016/j.xfnr.2023.10.002
Jayson Sueters M.Sc. , Freek A. Groenman M.D., Ph.D. , Mark-Bram Bouman M.D., Ph.D. , Jan Paul W.R. Roovers M.D., Ph.D. , Ralph de Vries M.Sc. , Theo H. Smit Ph.D. , Judith A.F. Huirne M.D., Ph.D.
Objective
Vaginoplasty is performed on approximately 20% of Dutch patients with male-to-female Gender Dysphoria (GD) and Mayer–Rokitansky–Küster–Hauser Syndrome (MRKHS). Various procedures are available, but comparisons of technique outcomes are lacking. The investigators aim to aid well-informed decision making by highlighting information gaps, weaknesses, and strengths.
Evidence Review
A systematic search in PubMed, EMBASE, Web of Science, and Scopus until October 7, 2022, by Population, Intervention, Comparator, Outcomes method and prospectively registered systematic reviews registration. Original retrospective studies on complete neovaginal creation were included. Inclusion criteria were original, peer-reviewed articles, ≥10 adult patients with MRKHS or transfeminine, ≥6 months postvaginoplasty, and report at least one outcome (anatomy, complications, complaints, satisfaction, sexual function, or quality of life [QoL]) with 5 patients with MRKHS or transfeminine needed as isolated patient population. Exclusion criteria were merged results of patient types (with control groups) and/or vaginoplasty techniques, unspecified vaginoplasty techniques, combined treatments, or vaginoplasty as secondary procedures. Methodological quality and potential bias were assessed by the Newcastle–Ottawa Scale and the National Institutes of Health Quality Assessment Tool. Outcome assessed anatomy, QoL, satisfaction, sexual function, complications, or complaints.
Results
Our search yielded 52 studies with 9 different vaginoplasty techniques. In total, 35 GD and 17 MRKHS studies were eligible. Mean vagina length was 8.3–16.2 cm and 7.6–16.4 cm, respectively. In patients with GD, hemorrhage (mean 0%–43.9%), necrosis (mean 0%–25.7%), prolapse (mean 0%–7.7%), stenosis (mean 0%–73.8%), gastrointestinal complications (mean 0%–8.3%), revisions (mean 3.2%–63.2%), pain (mean 3.1%–13.6%), discharge (mean 3.2%–6.7%), regret (mean 0%–6.5%), and fecal- (mean 3.2%–17.3%) and urinary issues (mean 1.3%–46.2%) were reported. Patients with MRKHS reported necrotic (mean 0%–16.7%) and stenotic complications (mean 0%–13.0%), discharge (mean 0%–100%), and prolapse (mean 0%–3.7%). Both patients with GD and MRKHS showed a high variation of Sexual activity (mean GD = 31.1%–86.7% and MRKHS = 21.2%–100%) and Dyspareunia (mean GD = 1.6%–50% and MRKHS = 0%–41.7%). Patients with MRKHS were more satisfied with anatomy (mean GD = 72.2%–100% and MRKHS = 100%).
Conclusion
For patients with GD and MRKHS, multiple vaginoplasty techniques improve QoL and self-image with low rates of complications/complaints and high satisfaction. However, the heterogenicity of outcome-measuring methods reflects the need for standardized validation tools. Direct technique comparisons per patient cohort and exploration of tissue-engineering methods are critical for future surgical advancements and well-informed decision making. T
{"title":"Vaginoplasty for gender dysphoria and Mayer–Rokitansky–Küster–Hauser syndrome: a systematic review","authors":"Jayson Sueters M.Sc. , Freek A. Groenman M.D., Ph.D. , Mark-Bram Bouman M.D., Ph.D. , Jan Paul W.R. Roovers M.D., Ph.D. , Ralph de Vries M.Sc. , Theo H. Smit Ph.D. , Judith A.F. Huirne M.D., Ph.D.","doi":"10.1016/j.xfnr.2023.10.002","DOIUrl":"10.1016/j.xfnr.2023.10.002","url":null,"abstract":"<div><h3>Objective</h3><p>Vaginoplasty is performed on approximately 20% of Dutch patients with male-to-female Gender Dysphoria (GD) and Mayer–Rokitansky–Küster–Hauser Syndrome (MRKHS). Various procedures are available, but comparisons of technique outcomes are lacking. The investigators aim to aid well-informed decision making by highlighting information gaps, weaknesses, and strengths.</p></div><div><h3>Evidence Review</h3><p>A systematic search in PubMed, EMBASE, Web of Science, and Scopus until October 7, 2022, by Population, Intervention, Comparator, Outcomes method and prospectively registered systematic reviews registration. Original retrospective studies on complete neovaginal creation were included. Inclusion criteria were original, peer-reviewed articles, ≥10 adult patients with MRKHS or transfeminine, ≥6 months postvaginoplasty, and report at least one outcome (anatomy, complications, complaints, satisfaction, sexual function, or quality of life [QoL]) with 5 patients with MRKHS or transfeminine needed as isolated patient population. Exclusion criteria were merged results of patient types (with control groups) and/or vaginoplasty techniques, unspecified vaginoplasty techniques, combined treatments, or vaginoplasty as secondary procedures. Methodological quality and potential bias were assessed by the Newcastle–Ottawa Scale and the National Institutes of Health Quality Assessment Tool. Outcome assessed anatomy, QoL, satisfaction, sexual function, complications, or complaints.</p></div><div><h3>Results</h3><p>Our search yielded 52 studies with 9 different vaginoplasty techniques. In total, 35 GD and 17 MRKHS studies were eligible. Mean vagina length was 8.3–16.2 cm and 7.6–16.4 cm, respectively. In patients with GD, hemorrhage (mean 0%–43.9%), necrosis (mean 0%–25.7%), prolapse (mean 0%–7.7%), stenosis (mean 0%–73.8%), gastrointestinal complications (mean 0%–8.3%), revisions (mean 3.2%–63.2%), pain (mean 3.1%–13.6%), discharge (mean 3.2%–6.7%), regret (mean 0%–6.5%), and fecal- (mean 3.2%–17.3%) and urinary issues (mean 1.3%–46.2%) were reported. Patients with MRKHS reported necrotic (mean 0%–16.7%) and stenotic complications (mean 0%–13.0%), discharge (mean 0%–100%), and prolapse (mean 0%–3.7%). Both patients with GD and MRKHS showed a high variation of Sexual activity (mean GD = 31.1%–86.7% and MRKHS = 21.2%–100%) and Dyspareunia (mean GD = 1.6%–50% and MRKHS = 0%–41.7%). Patients with MRKHS were more satisfied with anatomy (mean GD = 72.2%–100% and MRKHS = 100%).</p></div><div><h3>Conclusion</h3><p>For patients with GD and MRKHS, multiple vaginoplasty techniques improve QoL and self-image with low rates of complications/complaints and high satisfaction. However, the heterogenicity of outcome-measuring methods reflects the need for standardized validation tools. Direct technique comparisons per patient cohort and exploration of tissue-engineering methods are critical for future surgical advancements and well-informed decision making. T","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666571923000117/pdfft?md5=48e4acc6e8fca969a2b8d57aa79a3c87&pid=1-s2.0-S2666571923000117-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136127367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1016/j.xfnr.2023.08.001
Armin Ghomeshi B.S. , Boris Yang B.S. , Thomas A. Masterson M.D.
There is an increasing number of young men taking medications for chronic conditions, such as high blood pressure, psychiatric illness, and pain management. Furthermore, the prevalence of use for these medications only increases with age. However, despite the long-term indications for these treatments, the adverse effect on fertility is not well recognized. There are a plethora of clinical trials studying the effects of various medications on spermatogenesis in rodents; however, animal models do not fully translate to potential human side effects. Commonly prescribed medications may affect male fertility by altering hormone secretion or impairing testosterone secretion, sperm production, and ejaculation. Other drugs are known to increase erectile dysfunction and decrease libido. Although the evidence is not conclusive for many drug groups, this review presents the most compelling information on commonly prescribed drugs for male fertility. To our knowledge, this is the only review to compile information on commonly prescribed medications that may affect male fertility, sperm function, and libido. We believe that our review can help clinicians further personalize patient prescriptions based on their individual needs and goals as well as unveil an untapped area of research.
{"title":"The adverse effects of commonly used medications on male fertility: a comprehensive review","authors":"Armin Ghomeshi B.S. , Boris Yang B.S. , Thomas A. Masterson M.D.","doi":"10.1016/j.xfnr.2023.08.001","DOIUrl":"https://doi.org/10.1016/j.xfnr.2023.08.001","url":null,"abstract":"<div><p><span>There is an increasing number of young men taking medications for chronic conditions, such as high blood pressure, psychiatric illness, and pain management. Furthermore, the prevalence of use for these medications only increases with age. However, despite the long-term indications for these treatments, the adverse effect on fertility is not well recognized. There are a plethora of </span>clinical trials<span><span> studying the effects of various medications on spermatogenesis<span><span> in rodents; however, animal models do not fully translate to potential human side effects. Commonly prescribed medications may affect male fertility by altering hormone secretion or impairing </span>testosterone secretion, sperm production, and ejaculation. Other </span></span>drugs<span> are known to increase erectile dysfunction<span> and decrease libido. Although the evidence is not conclusive for many drug groups, this review presents the most compelling information on commonly prescribed drugs for male fertility. To our knowledge, this is the only review to compile information on commonly prescribed medications that may affect male fertility, sperm function, and libido. We believe that our review can help clinicians further personalize patient prescriptions based on their individual needs and goals as well as unveil an untapped area of research.</span></span></span></p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49882328","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 : 2023-07-01DOI: 10.1016/j.xfnr.2023.07.001
Yesim Bilmez M.Sc., Saffet Ozturk Ph.D.
Spermatogenesis is a strictly regulated, complex process by which sperm cells are continuously produced throughout a person’s lifespan. This process includes 3 unique events: mitotic division, meiosis, and spermiogenesis. Many genes playing key roles in these events are mainly regulated by epigenetic mechanisms, especially DNA methylation and histone modifications. Histone methylation is one of the basic modifications in histones and contributes to the timely control of transcriptional activation and repression of the genes implicated in cell cycle progression, meiotic recombination, DNA repair, chromosome segregation, and chromatin condensation. For this purpose, specific histone methyltransferases perform methylation of the lysine and/or arginine residues of histones localized in nucleosomes. Added methyl groups can be removed by exclusive histone demethylases when necessary. Potential defects in correctly establishing histone methylation marks in H3K4, H3K9, H3K27, H3K36, H4R3, and H4K20 residues in male germline cells during spermatogenesis may result in the development of infertility. In this review, we comprehensively evaluate histone methylation dynamics in male germ cells, from spermatogonia to sperm cells. In addition, infertility development in males is discussed in terms of altered histone methylation accumulation because of altered expression of the histone methyltransferases and histone demethylases.
{"title":"Dynamic changes of histone methylation in male germ cells during spermatogenesis","authors":"Yesim Bilmez M.Sc., Saffet Ozturk Ph.D.","doi":"10.1016/j.xfnr.2023.07.001","DOIUrl":"https://doi.org/10.1016/j.xfnr.2023.07.001","url":null,"abstract":"<div><p><span>Spermatogenesis<span><span> is a strictly regulated, complex process by which sperm cells are continuously produced throughout a person’s lifespan. This process includes 3 unique events: mitotic division, meiosis, and spermiogenesis. Many genes playing key roles in these events are mainly regulated by epigenetic mechanisms<span>, especially DNA methylation and </span></span>histone modifications<span>. Histone methylation is one of the basic modifications in </span></span></span>histones<span><span> and contributes to the timely control of transcriptional activation<span> and repression of the genes implicated in cell cycle progression, </span></span>meiotic recombination<span>, DNA repair, chromosome segregation<span>, and chromatin condensation<span><span>. For this purpose, specific histone methyltransferases<span> perform methylation of the lysine and/or arginine residues of histones localized in nucleosomes. Added methyl groups can be removed by exclusive </span></span>histone demethylases<span> when necessary. Potential defects in correctly establishing histone methylation marks in H3K4, H3K9, H3K27, H3K36, H4R3, and H4K20 residues in male germline cells during spermatogenesis may result in the development of infertility. In this review, we comprehensively evaluate histone methylation dynamics in male germ cells, from spermatogonia to sperm cells. In addition, infertility development in males is discussed in terms of altered histone methylation accumulation because of altered expression of the histone methyltransferases and histone demethylases.</span></span></span></span></span></p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49882329","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 : 2023-07-01DOI: 10.1016/j.xfnr.2023.08.002
Anne Z. Steiner M.D., M.P.H. (Editor in Chief, F&S Reviews)
{"title":"From the Editor’s Corner","authors":"Anne Z. Steiner M.D., M.P.H. (Editor in Chief, F&S Reviews)","doi":"10.1016/j.xfnr.2023.08.002","DOIUrl":"https://doi.org/10.1016/j.xfnr.2023.08.002","url":null,"abstract":"","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49882327","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}
To investigate the relationship between the number of oocytes and both the live birth rate (LBR) after fresh embryo transfer and the cumulative live birth rate (CLBR).
Evidence Review
The optimal number of oocytes necessary to expect a live birth after in vitro fertilization remains unclear. A systematic review with meta-analysis was performed, searching for studies published between January 2004 and March 2021. Two independent reviewers performed study selection and data extraction according to Cochrane methods. The mean-weighted threshold of optimal oocyte number was estimated from documented thresholds, followed by a one-stage meta-analysis on articles with documented or estimable relative risks.
Results
After reviewing 1,090 records, 102 full-text articles were assessed for eligibility. A total of 45 studies were available for quantitative syntheses. Twenty-two and 21 studies were included in the meta-analyses evaluating the relationship between the number of retrieved oocytes and LBR or CLBR, respectively. For LBR, most studies reported a plateau or a peak effect, corresponding to a weighted mean of 13.5 oocytes, and the pooled dose-outcome showed a nonlinear relationship, with a plateau or even a drop beyond 15 oocytes. The meta-analysis of the relationship between the number of oocytes and CLBR found a nonlinear relationship, with a continuous increase in CLBR, including for high-oocyte yields.
Conclusion
Above a 15-oocyte threshold, LBR after fresh transfer plateaus, advocating for a freeze-all strategy. In contrast, the continuous increase in CLBR suggests that a strong response to controlled ovarian stimulation seems unlikely to impair oocyte quality. High numbers of oocytes could be offered to improve the chances of cumulative live births, after evaluating the benefit–risk balance.
{"title":"Searching for the optimal number of oocytes to reach a live birth after in vitro fertilization: a systematic review with meta-analysis","authors":"Nathalie Sermondade M.D., Ph.D. , Charlotte Sonigo M.D., Ph.D. , Maud Pasquier M.D. , Naouel Ahdad-Yata M.D. , Eloïse Fraison M.D., M.Sc. , Michaël Grynberg M.D., Ph.D.","doi":"10.1016/j.xfnr.2023.03.002","DOIUrl":"https://doi.org/10.1016/j.xfnr.2023.03.002","url":null,"abstract":"<div><h3>Objective</h3><p><span>To investigate the relationship between the number of oocytes and both the live birth rate (LBR) after fresh </span>embryo transfer and the cumulative live birth rate (CLBR).</p></div><div><h3>Evidence Review</h3><p>The optimal number of oocytes necessary to expect a live birth after in vitro fertilization remains unclear. A systematic review with meta-analysis was performed, searching for studies published between January 2004 and March 2021. Two independent reviewers performed study selection and data extraction according to Cochrane methods. The mean-weighted threshold of optimal oocyte number was estimated from documented thresholds, followed by a one-stage meta-analysis on articles with documented or estimable relative risks.</p></div><div><h3>Results</h3><p>After reviewing 1,090 records, 102 full-text articles were assessed for eligibility. A total of 45 studies were available for quantitative syntheses. Twenty-two and 21 studies were included in the meta-analyses evaluating the relationship between the number of retrieved oocytes and LBR or CLBR, respectively. For LBR, most studies reported a plateau or a peak effect, corresponding to a weighted mean of 13.5 oocytes, and the pooled dose-outcome showed a nonlinear relationship, with a plateau or even a drop beyond 15 oocytes. The meta-analysis of the relationship between the number of oocytes and CLBR found a nonlinear relationship, with a continuous increase in CLBR, including for high-oocyte yields.</p></div><div><h3>Conclusion</h3><p>Above a 15-oocyte threshold, LBR after fresh transfer plateaus, advocating for a freeze-all strategy. In contrast, the continuous increase in CLBR suggests that a strong response to controlled ovarian stimulation seems unlikely to impair oocyte quality. High numbers of oocytes could be offered to improve the chances of cumulative live births, after evaluating the benefit–risk balance.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50204243","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 : 2023-04-01DOI: 10.1016/j.xfnr.2023.01.001
Navid Leelani D.O., Petar Bajic M.D., Neel Parekh M.D., Sarah C. Vij M.D., Scott D. Lundy M.D., Ph.D.
Male factor infertility continues to be a challenging condition with a significant proportion of men receiving no clear explanation for why they are unable to conceive. On the basis of the data presented in this review, there is now mounting evidence to support the role of the gut-testis axis in both healthy and diseased states, and at the core of this axis is the gut microbiome. Under nonpathological conditions, the gut microbiome maintains a symbiotic relationship with the testes. Disruption of the gut microbiome by diet or diseases initiates a chain reaction leading to diminishing fertility. Under dysbiotic conditions, there is an increase in inflammatory markers coupled with a loss of integrity of the gut epithelium leading to translocation of bacteria and inflammatory cytokines into systemic circulation. Ultimately, the testes along with the rest of the body are exposed to chronic inflammation because of this dysbiosis through pathways that remain to be fully elucidated. Eventually, this may also lead to loss of integrity of the blood-testis barrier causing impaired spermatogenesis and depressed semen parameters. Restoration of the gut microbiome to a symbiotic state via probiotics, fecal microbiota transplantation, bacteriophages, or small molecules may soon be able to decrease gut inflammation, rescue the integrity of the blood-testis barrier, and ultimately improve semen quality.
{"title":"The emerging role of the gut-testis axis in male reproductive health and infertility","authors":"Navid Leelani D.O., Petar Bajic M.D., Neel Parekh M.D., Sarah C. Vij M.D., Scott D. Lundy M.D., Ph.D.","doi":"10.1016/j.xfnr.2023.01.001","DOIUrl":"https://doi.org/10.1016/j.xfnr.2023.01.001","url":null,"abstract":"<div><p><span><span>Male factor infertility continues to be a challenging condition with a significant proportion of men receiving no clear explanation for why they are unable to conceive. On the basis of the data presented in this review, there is now mounting evidence to support the role of the gut-testis axis in both healthy and diseased states, and at the core of this axis is the gut microbiome. Under nonpathological conditions, the gut microbiome maintains a symbiotic relationship with the testes. Disruption of the gut microbiome by diet or </span>diseases initiates a chain reaction leading to diminishing fertility. Under dysbiotic conditions, there is an increase in inflammatory markers coupled with a loss of integrity of the </span>gut epithelium<span><span> leading to translocation of bacteria and inflammatory cytokines into systemic circulation<span><span>. Ultimately, the testes along with the rest of the body are exposed to chronic inflammation because of this </span>dysbiosis through pathways that remain to be fully elucidated. Eventually, this may also lead to loss of integrity of the blood-testis barrier causing impaired </span></span>spermatogenesis<span> and depressed semen parameters. Restoration of the gut microbiome to a symbiotic state via probiotics<span>, fecal microbiota transplantation, bacteriophages, or small molecules may soon be able to decrease gut inflammation, rescue the integrity of the blood-testis barrier, and ultimately improve semen quality.</span></span></span></p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50204246","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 : 2023-04-01DOI: 10.1016/j.xfnr.2023.02.001
Jeffrey Song B.A. , Mohit Khera M.D., M.B.A., M.P.H.
Spinal cord injury (SCI) is a prevalent problem, affecting nearly 288,000 people in the United States. Many men with SCI can present with erectile dysfunction (ED), anejaculation, and infertility, imputing profound impacts on quality of life for this population. Erectile dysfunction is generally well managed pharmacologically with phosphodiesterase-5 inhibitors and intracavernous injections or surgically with penile prosthesis. Additional treatment modalities, including vacuum constrictive devices and muscle stimulation, can be used to supplement pharmacological treatment of ED. Anejaculation is a prevalent problem, especially for men seeking to have children, but it is managed well with penile vibratory stimulation, electroejaculation, and testicular sperm extraction. Various sperm abnormalities are also prevalent in this population, with consensual support for the presence of hypospermia, asthenospermia, and necrospermia. Recent literature supports the potential use of probenecid and mirabegron to help improve these sperm abnormalities. The literature most consensually supports a high inflammatory state as the most likely pathological driver behind these sperm abnormalities. In all, ED, anejaculation, and infertility are managed relatively well in men with SCI. More work is needed to better understand the pathophysiology of sperm abnormalities to shed more light on better methods of treatment.
{"title":"Current concepts, therapies, and recommendations to assist fertility outcomes in male patients with spinal cord injury","authors":"Jeffrey Song B.A. , Mohit Khera M.D., M.B.A., M.P.H.","doi":"10.1016/j.xfnr.2023.02.001","DOIUrl":"https://doi.org/10.1016/j.xfnr.2023.02.001","url":null,"abstract":"<div><p><span>Spinal cord injury<span> (SCI) is a prevalent problem, affecting nearly 288,000 people in the United States. Many men with SCI can present with erectile dysfunction<span> (ED), anejaculation, and infertility, imputing profound impacts on </span></span></span>quality of life<span> for this population. Erectile dysfunction is generally well managed pharmacologically with phosphodiesterase-5 inhibitors and intracavernous injections<span><span> or surgically with penile prosthesis<span>. Additional treatment modalities, including vacuum constrictive devices and </span></span>muscle stimulation<span><span>, can be used to supplement pharmacological treatment of ED. Anejaculation is a prevalent problem, especially for men seeking to have children, but it is managed well with penile vibratory stimulation, electroejaculation, and testicular sperm extraction<span><span>. Various sperm abnormalities are also prevalent in this population, with consensual support for the presence of </span>hypospermia<span>, asthenospermia, and necrospermia. Recent literature supports the potential use of </span></span></span>probenecid<span> and mirabegron<span> to help improve these sperm abnormalities. The literature most consensually supports a high inflammatory state as the most likely pathological driver behind these sperm abnormalities. In all, ED, anejaculation, and infertility are managed relatively well in men with SCI. More work is needed to better understand the pathophysiology of sperm abnormalities to shed more light on better methods of treatment.</span></span></span></span></span></p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50204247","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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