F&S reviews最新文献

Objective

To summarize current knowledge regarding the outcomes of assisted reproductive technology (ART) in patients with adenomyosis, offer insights into the defects in the regulation of endometrial receptivity, and discuss the implications for the clinical management of adenomyosis and infertility.

Evidence Review

We conducted a comprehensive literature search of PubMed for original and review articles published in English up to June 2022 in the following areas: adenomyosis and infertility; ART; endometrial receptivity; and embryo implantation.

Results

Adenomyosis may have a negative impact on endometrial receptivity, reducing the probability of conception by ART. The severity of adenomyosis seems to be associated with the severity of the impairment in receptivity, and before treatment with a gonadotropin-releasing hormone agonist before frozen-thawed embryo transfer may restore endometrial receptivity. Molecular analyses demonstrated that genes associated with endometrial receptivity are aberrantly expressed in the eutopic endometria of women with infertility with adenomyosis. Hyperproliferation of the endometrial epithelium, impaired decidualization, progesterone resistance, altered expression of adhesion molecules, a hyperinflammatory microenvironment, chronic endometritis, and abnormal uterine contractility seem to be involved in the impairment of endometrial receptivity.

Conclusion

Uterine adenomyosis reduces endometrial receptivity via several mechanisms. In addition, data suggest that the etiologic mechanism of adenomyosis is responsible for impaired endometrial receptivity. Before treatment with a gonadotropin-releasing hormone agonist before frozen-thawed embryo transfer may ameliorate the defects in the uterine environment, probably by restoring the expression of genes that are essential for embryo implantation. Further research using animal models should aim to additionally clarify the relationship between adenomyosis and infertility to refine the treatment strategies for women with infertility with adenomyosis.

Objective

To pinpoint the knowledge gaps and systematically identify modifiable infertility-related socioeconomic and lifestyle risk factors in Asian women, since most studies on female infertility-related risk factors were conducted in the Western populations. This review pinpointed the knowledge gaps and aimed to systematically identify modifiable infertility-related socioeconomic and lifestyle risk factors in Asian women.

Evidence Review

We performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist from January 1, 1990, to October 31, 2021, in PubMed, the Web of Science, Embase, and Scopus, using a set of keywords related to our schemes, such as socioeconomics, lifestyle, infertility, and time to pregnancy. We shortlisted a combination of available full texts, English publications, original research articles, human subjects, and nonpregnant women of childbearing age with the intent of conceiving without medical assistance as the population of interest for further screening.

Results

We included 43 Asian studies that reported modifiable socioeconomic and lifestyle risk factors with the following outcomes: time to pregnancy; pregnancy rate; or infertility rate. Similar to the Western populations, female infertility in Asian women was associated with advanced age at marriage, sexual dysfunction, elevated stress levels, and greater adiposity. Interestingly, a higher socioeconomic status in Asian women was positively associated with female infertility, whereas a higher socioeconomic status in their male partners was inversely associated with couple infertility. Regrettably, few publications reported lifestyle risk factors, such as physical activity, dietary food groups, sleep disorders, and substance use.

Conclusion

Asian women may have more infertility-related cultural and dietary diversity, and it is worthy of future research efforts. It is also critical and more effective to tackle the infertility problem in both women and men. Hence, we discussed the imperative need for research efforts in Asian couples.

This is a comprehensive review evaluating current literature published on the impact of obesity and subsequent weight loss on male factor infertility. The prevalence of obesity is increasing worldwide, and it is projected that by 2030, >50% of all adults in the United States will be obese. Obesity, with excess adipose tissue, leads to a proinflammatory state with higher reactive oxygen species production, dysfunction of the hypothalamic-pituitary-gonadal axis, and subsequent alterations in spermatogenesis. There is growing evidence to support the negative impact of obesity on male factor fertility, specifically manifesting as reduced semen parameters. However, the male contribution to fertility goes beyond the standard semen analysis. As a result, in-depth molecular studies through metabolomics, proteomics, and epigenomics have been described to better understand male factor infertility and the impact of obesity on subfecundity. Given the obesity epidemic, there has been an increase in medically supervised weight loss programs and surgical intervention for weight loss. Bariatric surgery has become the mainstay of treatment for obesity. Early case reports documented a harmful impact of bariatric surgery on semen parameters; however, more recent prospective cohort studies identify no change in standard semen parameters after significant weight loss after bariatric surgery. Nonetheless, the clinical impact of bariatric surgery on fertility and ongoing clinical pregnancy when performed for obese male partners remains undetermined and an area for further study.

Despite improvements in in vitro fertilization success over the last 2 decades, the live birth rates do not exceed 65% even after transfer of a preimplantation genetic testing for aneuploidy normal blastocyst to a sonographically optimal endometrium. Consequently, there has been a search for more subtle endometrial factors that may deter sustained implantation and for treatments to mitigate these factors. Assays evaluating the window of implantation, markers of inflammation, normal vs. abnormal microbiome, and variations in the expression of endometrial proteins thought to be associated with implantation are commercially available and sought out by patients. The Endometrial Receptivity Assay aims to individualize embryo transfer timing but lacks sufficient data to support its use. Chronic endometritis may be associated with poor reproductive outcomes in some patients; however, accurate diagnosis is a challenge, and there is no high-quality evidence supporting routine assessment. Assessment of the uterine microbiome, ReceptivaDx, and the endometrial function test similarly do not have sufficient data to recommend routine testing in either the general infertility population or those who have experienced unsuccessful embryo transfer. Additional studies are needed to evaluate the endometrial contribution to implantation failure and what population, if any, may benefit from additional endometrial testing.

Although the first successful in vitro fertilization (IVF) cycle occurred over 40 years ago, the financial cost of IVF remains steep and prevents several patients from pursuing this option for infertility treatment. Institutional coverage for IVF varies widely depending on state or country, and some individuals may ultimately encounter no financial support. In some cases, surgical intervention (instead of or before IVF) could provide a less costly option or optimize IVF success to decrease the number of cycles needed for a successful pregnancy. Alterations in the individual components of the IVF process may cumulatively drive down overall costs. Changing stimulation protocols, medication regimens, or the medications themselves used during IVF could lead to similar pregnancy rates at lower costs. The addition of adjuncts to traditional IVF stimulation may further elevate the success rate. Monitoring of the patient’s response to stimulation medications and the genetic testing of embryos can be applied more judiciously in certain patient populations. Automation in established practices, such as intracytoplasmic sperm injection, may lead to decreased costs if broadly implemented. Patient-specific approaches using demographic and clinical factors to stratify patients on the basis of likelihood of success may enable providers to efficiently counsel patients to better financially plan for an IVF cycle.

The development of oncofertility over the past decade has renewed the interest in in vitro maturation (IVM) because of the specificity of some oncologic situations that may prevent the feasibility of controlled ovarian hyperstimulation. Immature cumulus-oocyte complexes can be recovered from the small antral follicles in any phase of the menstrual cycle within a very short time frame, offering the possibility of vitrifying mature oocytes or embryos after IVM in urgent situations or when stimulation is contraindicated. Cumulus-oocyte complexes and immature oocytes can be harvested either transvaginally or directly in the laboratory from extracorporeal ovarian tissue. Although IVM is no longer considered experimental as a result of safety studies, it relies on the extremely complex process of oocyte maturation. Despite some live births obtained after IVM in the context of fertility preservation, the lower developmental competence of in vitro–matured oocytes demonstrates the need to improve IVM culture systems. Recent advances in IVM systems may improve oocyte competence after IVM, thus tending to reduce the gap between IVM and ovarian stimulation outcomes. Moreover, to optimize the chances of conception in cancer survivors, the combination of IVM and ovarian tissue cryopreservation is the preferred option when ovarian stimulation cannot be performed.

Assisted reproductive technology (ART, defined here as including only in vitro fertilization and related technologies) is associated with increased adverse pregnancy, neonatal, and childhood developmental outcomes, even in singletons. The comparison group for many of these studies has often been a fertile population that conceived without assistance. The Massachusetts Outcome Study of Assisted Reproductive Technology (MOSART) was initiated to define a subfertile population with which to compare ART outcomes. Over >10 years, we have used the MOSART database to not only study pregnancy abnormalities and delivery complications but also evaluate ongoing health of women, infants, and children. This article will review studies from the MOSART in the context of how they compare with those of other investigations. We will present MOSART studies that identified the influence of ART and subfertility/infertility on adverse pregnancy (pregnancy hypertensive disorder, gestational diabetes, and placental abnormality) and delivery (preterm birth and low birth weight) outcomes as well as on maternal and child hospitalizations. We will provide evidence that although subfertility/infertility increases the risk of adverse outcomes, there is additional risk associated with the use of ART. Studies exploring the contribution of placental abnormalities as a factor adding to this increased ART-associated risk will be described.

Objective

To systematically review and summarize the literaure on nongenetic risk factors that may contribute to the racial disparity in uterine fibroids (UF) that disproportionality impacts Black individuals at 2-3 times the rate of White individuals and how the racial disparity has been studied to date.

Evidence Review

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol checklist guided the systematic review process. From January 1 to June 1, 2021, relevant articles were retrieved from PubMed, EMBASE, Web of Science, and Cochrane Library. Multiple investigators screened, assessed, extracted, and critically appraised the data.

Results

A total of 44 articles examined the relationship among UFs, race/ethnicity, and nongenetic risk factors, including cardiometabolic features, comorbidities, diet, chemical exposures, vitamin D levels, reproductive characteristics and socioeconomic factors, and life experiences. Most studies reported on the same 3 cohort study populations, and there was inconsistent statistical reporting of the race/ethnicity, risk factors, and UF relationship.

Conclusion

Many potential risk factors related to the racial disparity in UF have been studied thus far. There is still little conclusive evidence regarding which risk factors are the greatest contributors to racial disparities in UF. Promising areas of research deserve greater attention and a greater diversity of study populations and analytical methods.

The transgender and nonbinary (TGNB) communities face unique challenges when deciding to forego or pursue fertility because of gender-affirming medical or surgical interventions. Options for these patients have historically been limited because of overt discrimination within the healthcare system. The purpose of this comprehensive review is to discuss trends in TGNB reproductive access and healthcare over the past 2 decades and survey past and current legislation regarding TGNB reproductive rights. To better identify barriers for TGNB population and trends regarding fertility preservation, our review examines the attitudes, knowledge, and beliefs of both TGNB persons and healthcare providers. Second, we conduct a review of past and present legislation regarding reproductive rights and access related to TGNB care. The findings of our review demonstrate a failure to meet the standard of care for TGNB individuals in regard to fertility care, which likely contributes to the low uptake of fertility preservation services among this population. Furthermore, we find that healthcare providers must play a crucial role in advocating for systemic changes that can help alleviate barriers and provide equitable, gender-affirming care for TGNB individuals across the reproductive health spectrum.