F&S reviews最新文献

Polycystic ovary syndrome (PCOS) is a widespread endocrine disorder that affects women of reproductive age. Recent studies have demonstrated a close association between the gut microbiome and PCOS. Their microbial diversity may not significantly change, and the crucial role of Bacteroides spp. has been demonstrated in human PCOS. Furthermore, animal models of PCOS exhibit gut microbiome features different from those of humans with PCOS. The gut microbiome may differ in patients with PCOS because it can be affected by multiple PCOS-related factors. Dysbiosis of the gut microbiome may trigger PCOS symptoms via an underlying mechanism that may involve microbial metabolites, including bile acids, short-chain fatty acids, and lipopolysaccharides. The manipulation of the gut microbiome can affect PCOS phenotypes, and prebiotic or probiotic therapy has the potential to improve PCOS symptoms. Future mechanistic studies are required to identify the causative role of these microbes and their metabolites in the pathogenesis of PCOS.

Assisted reproductive technology (ART) procedures are mostly performed manually and require meticulous attention to details and precision in handling and timing. Automation of ART procedures would allow achieving standardization and reducing performance variability, the cost of medical treatment, and the risk of human error.

Some ART diagnostic devices are already available and offer objective tools of evaluation. However, automation of the entire spectrum of ART procedures is yet to come and can only be imagined as a platform capable of integrating all the separate technologies, successfully interconnecting them to guarantee a continued chain of custody of the gametes and embryos. The present update seeks to review the current potential for automation within the in vitro fertilization laboratory, with attention to sperm and oocyte manipulation and selection and to oocyte insemination with standard in vitro fertilization or intracytoplasmic sperm injection. An electronic search of PubMed was performed to identify articles in English that addressed automation in ART. Studies were classified in categories as randomized controlled trials, prospective controlled trials, prospective noncontrolled trials, retrospective studies, and experimental studies. Research and development data from the authors are included.

Objective

To conduct a comprehensive review of racial and ethnic health disparities in infertility care and treatment.

Evidence Review

Systematic literature searches were performed in PubMed and Embase from inception to April 2021. Studies were eligible for inclusion if they were original research performed in humans, observational study design, focused on circumstances contributing to infertility, access to infertility care, or outcomes of infertility treatment, and provided relevant information on racial or ethnic groups. Titles and abstracts were reviewed independently by two reviewers to identify pertinent articles. In addition, references of included articles were screened.

Result(s)

The PubMed search yielded 2,113 articles. An additional 2,301 articles were found in the Embase search. In total, 4,414 articles were screened on the basis of title and, where necessary, abstract. Thirty-four were found to meet the inclusion criteria and included in this review. Three additional studies were found from searching references of the included articles, resulting in 37 articles for discussion: 26 retrospective cohort studies, 2 prospective cohort studies, and 9 cross-sectional studies. The overall consensus in the literature is that reproductive health disparities on the basis of race and ethnicity impact fertility, access to care, and fertility treatment outcomes.

Conclusion(s)

Racial and ethnic differences in access to full-spectrum reproductive care, including infertility evaluation and treatment, remain. Despite access to infertility treatment, disparate treatment outcomes persist. Intrinsic and extrinsic factors, such as the institutionalization of racism and discrimination within medicine, remain influential in the diagnosis, care, and treatment outcomes of individuals with infertility. To address these inequities, we should mitigate provider bias, fund high-quality health disparity research, improve patient reproductive health knowledge, and advocate for increased access to treatment for all.

Objective

Primary ovarian insufficiency (POI) and nonobstructive azoospermia (NOA) both represent disease states of early, and often complete, failure of gametogenesis. Because oogenesis and spermatogenesis share the same conserved steps in meiosis I, it is possible that inherited defects in meiosis I could lead to shared causes of both POI and NOA. Currently, known genes that contribute to both POI and NOA are limited. In this review article, we provide a systematic review of genetic mutations in which both POI and NOA phenotypes exist.

Evidence Review

A PubMed literature review was conducted from January 1, 2000, through October 2020. We included all studies that demonstrated human cases of POI or NOA due to a specific genetic mutation either within the same family or in separate families.

Results

We identified 33 papers that encompassed 10 genes of interest with mutations implicated in both NOA and POI. The genes were all involved in processes of meiosis I.

Conclusion

Mutations in genes involved in processes of meiosis I may cause both NOA and POI. Identifying these unique phenotypes among shared genotypes leads to biologic plausibility that the key error occurs early in gametogenesis with an etiology shared among both male and female offspring. From a clinical standpoint, this shared relationship may help us better understand and identify individuals at a high risk of gonadal failure within families and suggests that clinicians obtain the history of opposite-sex family members when approaching a new diagnosis of POI or NOA.

Objective

To determine if SARS-CoV-2, which has led to the rapidly spreading COVID-19 global pandemic, is sexually transmitted. Since the putative receptor for the virus is identified in reproductive organs, it is also important to examine if COVID-19 may affect human fertility.

Evidence Review

A systematic review of English publications was conducted up to December 11, 2020 in PubMed, NIH iCite COVID-19 portfolio, Cochrane Library, and Google Scholar databases, searching for SARS-CoV-2 in the testes; seminal, prostatic, and vaginal fluids; and cervical smears. A total of 1,997 records were identified, duplicates were removed, and 1,490 records were reviewed for eligibility by examining titles and abstracts. Subsequently, 202 full-text relevant articles were reviewed by 2 independent reviewers. Forty-seven studies (literature reviews, editorials, and guidelines) were assessed qualitatively, and 23 studies that tested the male and female reproductive tracts of patients with COVID-19 for SARS-CoV-2 were quantitatively analyzed.

Results

No epidemiological investigations to date have described evidence suggesting that COVID-19 is an STD. While angiotensin-converting enzyme 2 receptor is found in the reproductive organs, the lack of co-expression of the TMPRSS2 modulatory protein, required for SARS-CoV-2 cell entry, in testicular cells, sperm, or oocytes, argues against the hypothesis that gametes transmit SARS-CoV-2. Molecular detection studies of SARS-CoV-2 RNA in the male and female reproductive tracts were summarized: 98.0% (293/299) of the seminal fluids, 16/17 testicular biopsies, all 89 prostatic fluids, 98.3% (57/58) of the vaginal fluids, all 35 cervical smears, and all 16 oocyte samples tested negative for SARS-CoV-2. None of the studies confirmed sexual transmission of SARS-CoV-2. Nonetheless, COVID-19 may have detrimental effects on male reproduction by inducing orchitis and/or decreasing testosterone levels, sperm counts, and motility.

Conclusion

On the basis of the current worldwide published information, COVID-19 is not an STD. This information is important for clinicians, proposed guidelines for public health, U.S. Food and Drug Administration guidelines for gamete and tissue donor eligibility, and fertility treatments. Universal precautions, currently practiced worldwide, are adequate and sufficient at this time to prevent the transmission of known or unknown viral infections. We suggest that recovered patients of COVID-19, especially those with infertility, should be evaluated for their ovarian and testicular function.

Albumin, a vital protein in cell culture systems, is derived from whole blood or blood products. The culture of human gametes and developing embryos for assisted reproductive technology (ART) uses albumin of human origin. Human serum albumin (HSA) is derived from expired blood obtained from blood banks. This blood has been stored in polyvinyl chloride bags made clear and flexible with di-2-ethylhexyl phthalate (DEHP). However, DEHP can leach from the bags into stored blood and cofractionate with HSA during albumin isolation. DEHP and its metabolite, mono-ethylhexyl phthalate, are known endocrine disruptors that are reported to have negative effects when directly supplemented in media for in vitro fertilization using gametes from a variety of animals. Therefore, the contamination of ART media with DEHP and mono-ethylhexyl phthalate through HSA supplementation may affect the outcomes of ART procedures. Although the embryology laboratory is strictly monitored to prevent a wide variety of contaminations, phthalate contamination of HSA has not been broadly examined. This review outlines the function of HSA in ART procedures and the production of HSA from whole blood. Finally, the review highlights the effects of acute phthalate exposures on gametes during in vitro procedures. Phthalates found in human serum albumin are present in media used for ART at levels that impair developmental endpoints in model species.

Objective

To characterize patient-reported barriers to equitable fertility care for racial/ethnic minority groups

Evidence Review

We conducted a systematic review of the following 6 databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines: Ovid Medline, Embase, CINAHL, Cochrane Library, ClinicalTrials.Gov, and PsycInfo. Citations of full-text articles were also manually searched in the Scopus database. Original research studies were eligible for inclusion if they reported patient-reported outcomes regarding racial/ethnic equity or cultural competence in fertility care. All racial and ethnic groups, including Black, Hispanic, South/East Asian, Pacific Islander, and Indigenous groups, were eligible for inclusion. Screening, extraction, and appraisal were completed in duplicate by 2 independent reviewers. The Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices and the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research were used to assess the risk of bias and methodological quality.

Results

Of 2,921 original database citations, we included 17 studies, which encompassed 3,743 patients from racial/ethnic minority and immigrant/refugee groups. The key patient-reported barriers included stigmatization of fertility care, lack of infertility knowledge, language barriers, discrimination, and lack of institutional trust. These barriers can create psychological distress for patients as well as prevent help-seeking for infertility. As such, the different approaches for equitable care included provision of multilingual services, involvement of physicians of diverse backgrounds, incorporation of preferred traditional healers, awareness of religious beliefs, and screening for psychosocial services. However, it is important to ensure that fertility providers do not inadvertently stereotype patients or rely on blanket assumptions. An open-ended approach to cultural humility is recommended.

Conclusions

It is important for healthcare providers to consider the unique barriers for fertility care for racial and ethnic minority groups. This review describes a number of implementable solutions for equitable fertility care.

Objective

To survey and assess modern methodologies used to test oocyte quality that have prognostic value in predicting assisted reproductive technology outcomes

Evidence Review

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we surveyed the English-language literature between January 1, 2010, and December 31, 2019, using PubMed, Scopus, and Embase databases. Two reviewers screened for articles focusing on oocyte quality markers that predict assisted reproductive technology outcomes, including embryo quality as well as fertilization, implantation, pregnancy, continued pregnancy, and live birth rates. Articles that did not mention oocytes or those that focused on nonhuman subjects, oocyte aging, oocyte maturation, embryo quality, interventions, or specific clinical diagnoses (endometriosis and polycystic ovarian syndrome) were deemed outside the scope of this analysis and excluded.

Results

Twenty-six relevant articles were identified, including 19 prospective and 7 retrospective studies (n = 2,210 patients). We identified 3 general approaches for oocyte quality assessment: morphological evaluation (11 articles), genomics and proteomics (13 articles), and artificial intelligence (2 articles). Morphological assessment did not show a consistent pattern of predictive value of predicting in vitro fertilization outcomes (7 articles in favor of its predictive value, 4 against). A considerable proportion of genomic and proteomic articles identified promising biomarkers that may predict pregnancy and live birth (12 in favor, 1 against). Machine learning is a rapidly growing frontier that minimizes subjectivity while potentially improving predictive ability (2 in favor).

Conclusion

Although there remains a lack of consensus on optimal methods to predict reproductive success, machine learning and genomics demonstrate promise in improving the understanding of oocyte quality assessment and prognostication.

Objective

To review the body of literature to summarize the existing knowledge about factors that shape gamete donor linking and discuss their implications for clinical care and future research. Recent changes in policy, practice, and technology have made it possible for individuals connected through donor conception—donor-conceived (DC) people, parents, and donors—to find and contact one another.

Evidence Review

A bibliographic search of English, French, German, Spanish, and Dutch language peer-reviewed publications was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the electronic databases PubMed, EMBASE, and Web of Science Core Collection. The inclusion criteria were as follows: original empirical research with quantitative, qualitative, or mixed methods; research participants were DC people, gamete donors, and/or parents interested in searching for people (genetically) related to them through gamete donation; and a substantial part of the article focused on searching for or an interest in contacting donor-related people. The exclusion criteria were as follows: publications other than original peer-reviewed research and publications on known donors and surrogacy. Methodological quality was assessed using the Critical Appraisal Skills Program checklist for qualitative studies and the Joanna Briggs Institute Critical Appraisal Checklist for quantitative studies. Eligibility assessments, quality assessments, and data extraction were independently performed by 2 teams, with disagreements resolved by discussion.

Results

An initial search yielded 4,040 publications, of which 119 articles were full-text screened and 47 studies were included for review. The studies were diverse in design, setting, recruitment methods, data collection, and stakeholder groups. The DC people, parents, and donors of the studies included had an interest in each other; however, their motives, desired information, and/or expectations regarding their interest and/or seeking contact differed. Among the participants in the studies, the interests of the DC people, parents, and donors were intertwined and not necessarily in conflict. Methodological limitations of the included studies were identified.

Conclusion

Donor linking occurred in a complex array of several factors: psychosocial, sociodemographic, relational, and environmental variables. Further research is needed to better understand the relative influence of these variables and identify the psychosocial needs of the different groups. Preliminary findings showed that stakeholders can have an interest in an ongoing contact. However, the studies’ methodological shortcomings limited the extent to which these findings could be applied to all people interested in donor-related contact. Follow-up research is needed on what happens after parties are li