F&S reviews最新文献

Objective

To evaluate the role of the plasminogen activator (PA) system throughout the endometrial cycle, including the effects of intrauterine contraception, and assess the contribution of genetic mutations in the PA system to the clinical problem of heavy menstrual bleeding (HMB).

Evidence Review

This was a systematic review of the PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases from 1966 until the search date in October 2021. The publications included were cohort studies, observational studies, case reports, case studies, and case-control studies. Literature reviews were excluded. Abstracts were screened by 3 investigators independently, with subsequent review by the senior investigator to assess study quality. The Risk of Bias In Non-Randomized Studies of Interventions assessment tool was used to evaluate potential sources of bias in the included studies.

Results

A total of 2,021 unique articles were identified, 38 of which qualified for full review, with 17 excluded during that process, leaving 21 articles that met all criteria. Studies reported that the activity of the PA system in the endometrium changed throughout the menstrual cycle, with increases in tissue PA and PA inhibitor 1 (PAI-1) activity surrounding the menstrual phase. Greater fibrinolytic activity was also observed in the endometrial samples of women with HMB as well as those with copper intrauterine devices. Conversely, levonorgestrel intrauterine devices were associated with a decrease in the tissue PA–to–PAI-1 ratio, hence reduced fibrinolysis. Mutations of the PAI-1 and α₂-antiplasmin genes were found to affect the PA system and are associated with HMB.

Conclusion

Genetic mutations that affect the PA system and are linked to alterations in menstrual bleeding, such as PAI-1 and α₂-antiplasmin, have been identified. Further research is needed to ascertain whether additional mutations, and genetic polymorphisms, not only affect the PA system but may also explain some cases of HMB that are yet to be classified.

It is important to closely examine trends in reproduction during a pandemic because it provides not only the foundation for an improved future response but also crucial insights regarding the disparate impact across different races and socioeconomic classes. The coronavirus disease 2019 pandemic is a prime example of the impact a pandemic can have on a nation’s reproductive health. Contraception and abortion access became more difficult with more barriers to access, likely contributing to increasing unintended pregnancy rates. Underrepresented minorities and vulnerable populations were disproportionately affected by the virus on their reproductive health as well as by the virus itself. As the first ever messenger ribonucleic acid vaccine in conjunction with the lack of inclusion of pregnant and peripartum women in initial studies and conflicting and misinformation on social media, the initial role of the coronavirus disease 2019 vaccine in women of reproductive age was unclear. Further research inclusive of this group of women has led to the consensus by major medical societies to recommend vaccination of women regardless of pregnancy or lactating status.

Examining these topics in depth will lead to the development of strategies that can be employed to mitigate the negative effects on reproductive health during the current pandemic and can also be applied to future strategic plans to prevent similar negative outcomes.

Objective

To investigate the effectiveness of the endometrial receptivity array (ERA) test on in vitro fertilization (IVF) outcomes.

Evidence Review

The PubMed/MEDLINE, ScienceDirect, and Scopus databases were searched. We included studies investigating IVF outcomes between patients who underwent standard embryo transfer and personalized embryo transfer (PET) guided by the ERA results. The main outcome measures were the implantation rate, clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, and live birth rate (LBR). The random-effects model was applied to pool data. We evaluated cohort and randomized controlled trial studies using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and the Cochrane Collaboration tool.

Results

Seventeen studies (7,052 patients, 4 randomized controlled trials, and 13 cohort studies) were included in this meta-analysis. Personalized embryo transfer on the basis of ERA was not found to optimize the gestational outcomes, including the implantation rate (risk ratio [RR], 1; 95% confidence interval [CI], 0.83–1.2), clinical pregnancy rate (RR, 0.99; 95% CI, 0.85–1.15), ongoing pregnancy rate (RR, 0.99; 95% CI, 0.89–1.11), and miscarriage rate (RR, 1.12; 95% CI, 0.81–1.54). Further subgroup analysis indicated that patients undergoing PET in the first IVF cycle had a markedly increased LBR (RR, 1.24; 95% CI, 1.03–1.49). Conversely, PET among patients with a history of recurrent implantation failure did not enhance the LBR (RR, 0.86; 95% CI, 0.64–1.36).

Conclusion

Endometrial receptivity array shows no significant improvement in IVF outcomes except in the LBR for patients undergoing the first IVF cycle. Additional research is required to ascertain the efficacy of ERA before achieving wider usage.

PROSPERO Number

CRD42021255124.

Uterine leiomyomas are the most common pelvic tumor affecting women. Seventy percent of women will present with them at some point in their lives. Despite this, there is a lack of appropriate pharmacotherapeutic agents and preventive measures, and its etiology and pathophysiology are not properly understood, mainly because of the lack of reliable in vivo models. A systematized review was performed to analyze all reported vivo models of uterine fibroids, consolidate current understanding, and guide further research on the topic. We aim to contribute to those who wish to develop novel models and those who want to reproduce current ones to study the effects of new drugs on the disease or its pathogenic mechanisms. Literature searches with the key words “leiomyoma,” “myoma,” “fibroid,” “uterine fibroid,” “xenografting,” and “experimental animal model” were conducted in PubMed, Embase, and LILACS. Several novel models of leiomyomas have been proposed lately for a variety of animal species. We have discussed the findings, advantages, and limitations of the existing animal models of uterine fibroids, besides explaining the rationale behind their use. Researchers must be aware of limitations of the existing models and choose the model that best fits their needs. To facilitate reproducibility and translation of findings, methods must be described in detail. Given the context, special attention should be paid when providing conclusions. Besides equivalent histology and immunomarkers, a trustworthy model should also display all of the genetic expressions of human myomas.

Objective

To identify models predicting live birth or ongoing pregnancy in couples with unexplained recurrent pregnancy loss (RPL) and evaluate the risk of bias, performance, generalizability, and applicability of these models.

Evidence Review

A systematic literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library until December 2020. Studies were eligible for inclusion if they were original studies predicting pregnancy outcome in patients with unexplained RPL and presented a tool that allowed for individual predictions. The risk of bias and applicability of the studies were assessed using the Prediction model Risk of Bias Assessment Tool. The Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement was used to assess reporting quality.

Results

The search yielded 1,170 unique articles that were screened on the basis of the title and abstract. Seven studies were included: 1 prospective cohort study and 6 retrospective cohort studies. The recommended steps for the development of a prediction model were not followed by any of the studies, although 6 were published before the Prediction model Risk of Bias Assessment Tool and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines. The included studies had a high risk of bias and were not externally validated.

Conclusion

International guidelines recommend supportive care programs with prognostic counseling for couples with unexplained RPL. This information manages the expectations of couples and improves their ability to make an informed decision regarding further pregnancy attempts. On the basis of the results of this study, we cannot recommend the use of any of the studied prediction models in clinical practice to prevent overestimation of chances and false belief.